Basic Information
| Provider Information | |||||||||
| NPI: | 1659531135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDER | ||||||||
| FirstName: | MONIQUE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 NW 75TH AVE APT 103 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333135152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865668189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2708 NE 14TH ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330623565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546037885 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.