Healthcare Provider Details

I. General information

NPI: 1770968174
Provider Name (Legal Business Name): TRUE BLUE PEDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 E. BRANDON BLVD
BRANDON FL
33511
US

IV. Provider business mailing address

1810 FLAT BRANCH CT.,
VALRICO FL
33594
US

V. Phone/Fax

Practice location:
  • Phone: 813-486-1718
  • Fax: 813-643-4591
Mailing address:
  • Phone: 813-486-1718
  • Fax: 813-643-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DHARINI ZAVERI
Title or Position: OTR/L MGR OCC. THERAPIST
Credential: OTR/L
Phone: 813-643-4591