Provider Demographics
NPI:1508990219
Name:KOURI, RUTHANNE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:RUTHANNE
Middle Name:
Last Name:KOURI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-242-7747
Mailing Address - Fax:954-989-3786
Practice Address - Street 1:8255 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-242-7747
Practice Address - Fax:954-989-3786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ023DOtherBC BS
FLE7778AMedicare PIN