Provider Demographics
NPI:1760453666
Name:BINETT, NIVIA L (OT)
Entity Type:Individual
Prefix:
First Name:NIVIA
Middle Name:L
Last Name:BINETT
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 1:2475 SW 103RD WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3984
Mailing Address - Country:US
Mailing Address - Phone:305-389-1769
Mailing Address - Fax:954-441-4458
Practice Address - Street 1:10031 PINES BLVD
Practice Address - Street 2:SUITE 217
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6179
Practice Address - Country:US
Practice Address - Phone:305-389-1769
Practice Address - Fax:954-441-4458
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888471400Medicaid
FL888471400Medicaid