Provider Demographics
NPI:1619597028
Name:GOLDWASER, AGNIESZKA MARTA (OT)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MARTA
Last Name:GOLDWASER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8897 RAVEN ROCK CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4831
Mailing Address - Country:US
Mailing Address - Phone:954-249-4207
Mailing Address - Fax:
Practice Address - Street 1:7225 BOCA DEL MAR DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5517
Practice Address - Country:US
Practice Address - Phone:561-362-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9880225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation