Provider Demographics
NPI:1861631822
Name:COLEMAN, RAENI (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:RAENI
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
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 1:6200 SW 73RD ST
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:5975 SUNSET DR STE 100
Practice Address - Street 2:CHILD DEVELOPMENT CENTER
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5198
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:786-662-5081
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010058700Medicaid
FL1982688230OtherHOSPITAL