MEDICARE: LIVE AND LEARN THERAPY, LLC

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	OT15033	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871097279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE AND LEARN THERAPY, LLC

Provider Business Mailing Address
First Line	:	3016 S OAKLAND FOREST DR APT 2906
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5610
Country	:	US
Telephone Number	:	954-634-2354
Fax Number	:	954-206-0919

Provider Business Practice Location Address
First Line	:	3016 S OAKLAND FOREST DR APT 2906
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5610
Country	:	US
Telephone Number	:	954-634-2354
Fax Number	:	954-206-0919

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MISS FABIOLA CONILLE
Credential	:	OTR/L
Telephone Number	:	954-634-2354

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	02/13/2022

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Directions to “LIVE AND LEARN THERAPY, LLC ” Practice Location

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