Healthcare Provider Details

I. General information

NPI: 1124609854
Provider Name (Legal Business Name): TRISHA SAMANTHA SUNDBERG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 BERACASA WAY STE 102
BOCA RATON FL
33433-3453
US

IV. Provider business mailing address

961 LYONS PARK DR
POMPANO BEACH FL
33060-8712
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-2033
  • Fax: 561-939-2037
Mailing address:
  • Phone: 954-330-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: