Basic Information
| Provider Information | |||||||||
| NPI: | 1790931657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S PINE ISLAND RD | ||||||||
| Address2: | S300 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544769077 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S PINE ISLAND RD | ||||||||
| Address2: | S300 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544769077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XE1200X | OT2016 | ZZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
ID Information
| ID | Type | State | Issuer | Description | OT2016 | 01 | FL | LICENSE NUMBER | OTHER |