Organization
LOIS GOLD OTR PA
Active
Organization
LOIS GOLD OTR PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYANNE A. GOLDBERG (OFFICE MANAGER)
(305) 448-7101
Entity
Organization
Contact information
Practice address
2645 SW 37TH AVE., #304, MIAMI, FL 33133
(305) 448-7101
(305) 442-8730
Mailing address
2645 SW 37TH AVE., #304, MIAMI, FL 33133
(305) 448-7101
(305) 442-8730
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT 963
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889850200
—
FL
Enumeration date
11/29/2006
Last updated
05/31/2011
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