Provider Demographics
NPI:1215635164
Name:PAVING WAYS THERAPEUTIC SERVICES INC.
Entity type:Organization
Organization Name:PAVING WAYS THERAPEUTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:LAVERNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:786-216-5453
Mailing Address - Street 1:4311 SW 160TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5761
Mailing Address - Country:US
Mailing Address - Phone:786-216-5453
Mailing Address - Fax:
Practice Address - Street 1:4311 SW 160TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5761
Practice Address - Country:US
Practice Address - Phone:786-216-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112232500Medicaid