Basic Information
Provider Information
NPI: 1225689953
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROTENBERG
FirstName: REBECCA
MiddleName: BATYA
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8477 S SUNCOAST BLVD
Address2:  
City: HOMOSASSA
State: FL
PostalCode: 344465028
CountryCode: US
TelephoneNumber: 3523827214
FaxNumber: 3523827781
Practice Location
Address1: 5200 NE 2ND AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331372706
CountryCode: US
TelephoneNumber: 3057518626
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2019
LastUpdateDate: 09/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT16336FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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