Provider Demographics
NPI:1679631345
Name:SPIVAK, IRINA (OTR)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SPIVAK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21061 WINDEMERE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1116
Mailing Address - Country:US
Mailing Address - Phone:305-776-6577
Mailing Address - Fax:
Practice Address - Street 1:21061 WINDEMERE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1116
Practice Address - Country:US
Practice Address - Phone:305-776-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18616225X00000X
FLOT12400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023072900Medicaid
FL891630600Medicaid