Healthcare Provider Details

I. General information

NPI: 1760639066
Provider Name (Legal Business Name): SOUTHERN OCCUPATIONAL THERAPY PRODUCTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4750
US

IV. Provider business mailing address

690 JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4750
US

V. Phone/Fax

Practice location:
  • Phone: 772-708-3751
  • Fax: 772-225-0843
Mailing address:
  • Phone: 772-708-3751
  • Fax: 772-225-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT1145
License Number StateFL

VIII. Authorized Official

Name: MS. CARON ALICE FAHERTY
Title or Position: PRESIDENT
Credential: MS, OTR, CSFA
Phone: 772-708-3751