Provider Demographics
NPI:1588098982
Name:AUGUSTE ISMA, ANIDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANIDA
Middle Name:
Last Name:AUGUSTE ISMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 NW 6TH PL
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6343
Mailing Address - Country:US
Mailing Address - Phone:954-547-0770
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3650
Practice Address - Country:US
Practice Address - Phone:954-353-8777
Practice Address - Fax:954-389-1990
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist