Provider Demographics
NPI:1518138684
Name:KHAZEM, RIMA
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:KHAZEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8783 SONOMA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4068
Mailing Address - Country:US
Mailing Address - Phone:954-260-0935
Mailing Address - Fax:
Practice Address - Street 1:8783 SONOMA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4068
Practice Address - Country:US
Practice Address - Phone:954-260-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0T8765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist