Healthcare Provider Details

I. General information

NPI: 1487721585
Provider Name (Legal Business Name): OCEAN ONE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/06/2023
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 S NOVA RD STE 113
ORMOND BEACH FL
32174-8470
US

IV. Provider business mailing address

495 S NOVA RD STE 113
ORMOND BEACH FL
32174-8470
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-4300
  • Fax: 386-615-9216
Mailing address:
  • Phone: 386-677-4300
  • Fax: 386-615-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1299450001
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID E CARN
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: RPT
Phone: 386-677-4300