Provider Demographics
NPI:1215347984
Name:REZNIK, KEREN
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 E COUNTRY CLUB DR
Mailing Address - Street 2:#302
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19900 E COUNTRY CLUB DR
Practice Address - Street 2:#302
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3327
Practice Address - Country:US
Practice Address - Phone:786-663-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist