Provider Demographics
NPI:1306185780
Name:VAN VUUREN, JANIS REBEKAH (BS, MOT, OT/L)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:REBEKAH
Last Name:VAN VUUREN
Suffix:
Gender:F
Credentials:BS, MOT, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 CRYSTAL WAY
Mailing Address - Street 2:APT L
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1030
Mailing Address - Country:US
Mailing Address - Phone:561-324-8189
Mailing Address - Fax:
Practice Address - Street 1:12777 FOREST HILL BLVD
Practice Address - Street 2:SUITE 1504
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4775
Practice Address - Country:US
Practice Address - Phone:561-665-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT15615225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist