Provider Demographics
NPI:1982849253
Name:SHOTTS QUALITY CARE, INC
Entity Type:Organization
Organization Name:SHOTTS QUALITY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IZASKU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/ L
Authorized Official - Phone:305-364-4331
Mailing Address - Street 1:16969 NW 67TH AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4214
Mailing Address - Country:US
Mailing Address - Phone:305-364-4331
Mailing Address - Fax:305-364-4332
Practice Address - Street 1:16969 NW 67TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4214
Practice Address - Country:US
Practice Address - Phone:305-364-4331
Practice Address - Fax:305-364-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty