Healthcare Provider Details

I. General information

NPI: 1235460999
Provider Name (Legal Business Name): OCCUPATIONAL PERFORMANCE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 SHERIDAN ST SUITE 100
HOLLYWOOD FL
33021-2834
US

IV. Provider business mailing address

6245 N FEDERAL HWY SUITE 300
FORT LAUDERDALE FL
33308-1998
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-3277
  • Fax: 954-744-0178
Mailing address:
  • Phone: 954-957-7171
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HARKINS
Title or Position: CFO
Credential:
Phone: 954-957-7171