Healthcare Provider Details

I. General information

NPI: 1164507422
Provider Name (Legal Business Name): OCCUPATIONAL AND REHABILITATION CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE FL
32257-1086
US

IV. Provider business mailing address

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE FL
32257-1086
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-3011
  • Fax: 904-260-3170
Mailing address:
  • Phone: 904-260-3011
  • Fax: 904-260-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLENE TAN
Title or Position: ADMINISTRATOR/CHIEF LEGAL OFFICER
Credential: JD
Phone: 904-260-3011