Provider Demographics
NPI:1275187304
Name:MINSAL, REBECCA J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:MINSAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:ORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CORAL WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3053
Mailing Address - Country:US
Mailing Address - Phone:786-636-4351
Mailing Address - Fax:
Practice Address - Street 1:3400 CORAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3053
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20234225X00000X
FLOT20234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103775600Medicaid