Provider Demographics
NPI: | 1922487990 |
---|---|
Name: | BECKER, VALLERIE |
Entity Type: | Individual |
Prefix: | |
First Name: | VALLERIE |
Middle Name: | |
Last Name: | BECKER |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 11 EAGLE ROCK AVE STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | EAST HANOVER |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07936-3167 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-887-9000 |
Mailing Address - Fax: | 973-887-3816 |
Practice Address - Street 1: | 231 N NEW YORK AVE |
Practice Address - Street 2: | |
Practice Address - City: | WINTER PARK |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32789-3117 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-599-3700 |
Practice Address - Fax: | 407-599-3701 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2015-05-24 |
Last Update Date: | 2019-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OTA11783 | 224Z00000X |
OR | 285096 | 224Z00000X |
FL | OT20015 | 225X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |