Provider Demographics
NPI:1558471623
Name:RAIFMAN, ROBERT MICHAEL (MOT, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:RAIFMAN
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 SE LEXINGTON LAKES DR
Mailing Address - Street 2:#104
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5400
Mailing Address - Country:US
Mailing Address - Phone:772-287-7847
Mailing Address - Fax:
Practice Address - Street 1:3041 SE LEXINGTON LAKES DR
Practice Address - Street 2:#104
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5400
Practice Address - Country:US
Practice Address - Phone:561-251-6769
Practice Address - Fax:772-287-7847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888003496Medicaid
FLZ074BOtherBLUE CROSS/BLUE SHIELD FL
FL888003400Medicaid