Provider Demographics
NPI:1720174295
Name:PATEL, JYOTI (MOT OTRL)
Entity Type:Individual
Prefix:MS
First Name:JYOTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 WESTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1976
Mailing Address - Country:US
Mailing Address - Phone:954-683-6896
Mailing Address - Fax:954-349-2903
Practice Address - Street 1:1290 WESTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1976
Practice Address - Country:US
Practice Address - Phone:954-683-6896
Practice Address - Fax:954-349-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9969225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886538800Medicaid
FLZ9608OtherBCBS OF FLORIDA