Healthcare Provider Details

I. General information

NPI: 1285450726
Provider Name (Legal Business Name): BOCA DEVELOPMENTAL THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9293 GLADES RD STE C
BOCA RATON FL
33434-3905
US

IV. Provider business mailing address

9293 GLADES RD STE C
BOCA RATON FL
33434-3905
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-3606
  • Fax:
Mailing address:
  • Phone: 561-367-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANA WEINE
Title or Position: CO-OWNER
Credential: M.S.
Phone: 312-493-4641