MEDICARE: MS. HEATHER NOEL OTRL

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	OT11299	FL

General Provider Information

NPI Number	:	1942323316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER NOEL OTRL

Provider Business Mailing Address
First Line	:	11011 SHERIDAN STREET
Second Line	:	SUITE 302
City	:	COOPER CITY
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST
Second Line	:	SUITE 302
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1505
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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