Provider Demographics
NPI:1790931657
Name:GOLDBERG, JUDY V (OT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:V
Last Name:GOLDBERG
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 1:600 S PINE ISLAND RD
Mailing Address - Street 2:S300
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3166
Mailing Address - Country:US
Mailing Address - Phone:954-473-6344
Mailing Address - Fax:954-476-9077
Practice Address - Street 1:600 S PINE ISLAND RD
Practice Address - Street 2:S300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3166
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:954-476-9077
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZOT2016225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT2016OtherLICENSE NUMBER