Provider Demographics
NPI:1083754394
Name:FEINER-TRACHTENBERG, ADRIENNE SHARI (M,OT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:SHARI
Last Name:FEINER-TRACHTENBERG
Suffix:
Gender:F
Credentials:M,OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 N CONGRESS AVE
Mailing Address - Street 2:398
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8205
Mailing Address - Country:US
Mailing Address - Phone:561-731-1974
Mailing Address - Fax:
Practice Address - Street 1:1779 N CONGRESS AVE
Practice Address - Street 2:398
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8205
Practice Address - Country:US
Practice Address - Phone:561-731-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9138225X00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8856044Medicaid