Provider Demographics
NPI:1326489303
Name:FAIN, ANTHONY W (OTA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:FAIN
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25054 SW 123RD PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5946
Mailing Address - Country:US
Mailing Address - Phone:305-710-0686
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2018
Practice Address - Country:US
Practice Address - Phone:305-267-4414
Practice Address - Fax:305-267-4846
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 9844224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant