MEDICARE: STEPHANIE MARIE SUBIRATS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT19284	FL

General Provider Information

NPI Number	:	1801387030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE SUBIRATS

Provider Business Mailing Address
First Line	:	14552 LARKSPUR LN
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 NORTHLAKE BLVD STE 203
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1711
Country	:	US
Telephone Number	:	561-814-5400
Fax Number	:	561-814-5463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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