Provider Demographics
NPI:1962870766
Name:KLEIN, SHIRAH (COTA/L)
Entity type:Individual
Prefix:
First Name:SHIRAH
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 NE 12TH AVENUE
Mailing Address - Street 2:#607
Mailing Address - City:HALLENDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:347-628-0394
Mailing Address - Fax:
Practice Address - Street 1:320 NE 12TH AVE
Practice Address - Street 2:#607
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4505
Practice Address - Country:US
Practice Address - Phone:347-628-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14291224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant