Healthcare Provider Details

I. General information

NPI: 1174639272
Provider Name (Legal Business Name): DLJ THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8138 SUN VISTA WAY
ORLANDO FL
32822-7538
US

IV. Provider business mailing address

PO BOX 140132
ORLANDO FL
32814-0123
US

V. Phone/Fax

Practice location:
  • Phone: 407-484-6563
  • Fax:
Mailing address:
  • Phone: 407-484-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11106
License Number StateFL

VIII. Authorized Official

Name: DANIEL LINARES
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 407-484-6563