Healthcare Provider Details

I. General information

NPI: 1396106654
Provider Name (Legal Business Name): HIGHLANDS OCCUPATIONAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EAST EDGEWOOD DRIVE SUITE 114
LAKELAND FL
33803
US

IV. Provider business mailing address

123 US HWY 27 NORTH
SEBRING FL
33870
US

V. Phone/Fax

Practice location:
  • Phone: 863-606-5948
  • Fax: 863-937-9224
Mailing address:
  • Phone: 863-471-6303
  • Fax: 863-471-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN CASTELLI JR.
Title or Position: CORP. SECRETARY
Credential:
Phone: 863-471-6303