Provider Demographics
NPI:1417049735
Name:MERHAI, MADHUMATTI (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADHUMATTI
Middle Name:
Last Name:MERHAI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4513
Mailing Address - Country:US
Mailing Address - Phone:954-599-1405
Mailing Address - Fax:954-389-1408
Practice Address - Street 1:1461 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4513
Practice Address - Country:US
Practice Address - Phone:954-599-1405
Practice Address - Fax:954-389-1408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11419225X00000X
FLOT11419222Q00000X
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
FL889530900Medicaid