Basic Information
Provider Information
NPI: 1508391087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIKAIEL
FirstName: CAROLINE
MiddleName: SHERIE
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3938 S TAMIAMI TRL
Address2:  
City: SARASOTA
State: FL
PostalCode: 342313622
CountryCode: US
TelephoneNumber: 8669891114
FaxNumber: 9419570033
Practice Location
Address1: 1 OAKWOOD BLVD STE 130
Address2:  
City: HOLLYWOOD
State: FL
PostalCode: 330201937
CountryCode: US
TelephoneNumber: 9549253844
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/21/2017
LastUpdateDate: 05/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT18398FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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