Provider Demographics
NPI:1669621322
Name:SANDHAUS, MIRYAM D (OT)
Entity type:Individual
Prefix:
First Name:MIRYAM
Middle Name:D
Last Name:SANDHAUS
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:PO BOX 802031
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33280-2031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19999 E COUNTRY CLUB DR
Practice Address - Street 2:APT 407
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3081
Practice Address - Country:US
Practice Address - Phone:732-421-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13322225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist