Provider Demographics
NPI:1407130677
Name:EXCEPTIONAL REHAB
Entity Type:Organization
Organization Name:EXCEPTIONAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:ROSINA
Authorized Official - Middle Name:ELVIRA
Authorized Official - Last Name:LEVY CHEVEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:305-310-3267
Mailing Address - Street 1:3621 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3636
Mailing Address - Country:US
Mailing Address - Phone:305-223-0007
Mailing Address - Fax:305-223-0008
Practice Address - Street 1:3621 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3636
Practice Address - Country:US
Practice Address - Phone:305-223-0007
Practice Address - Fax:305-223-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002596900Medicaid