Healthcare Provider Details

I. General information

NPI: 1649579350
Provider Name (Legal Business Name): DLC REHAB SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4464 WEST 15 AVE
HIALEAH FL
33012
US

IV. Provider business mailing address

4464 W 15TH AVE
HIALEAH FL
33012-3358
US

V. Phone/Fax

Practice location:
  • Phone: 786-512-3874
  • Fax:
Mailing address:
  • Phone: 786-512-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 13643
License Number StateFL

VIII. Authorized Official

Name: KATIA DE LA CRUZ
Title or Position: PRESIDENT
Credential: MS, OTR/L
Phone: 786-512-3874