Healthcare Provider Details

I. General information

NPI: 1639724750
Provider Name (Legal Business Name): OCCUPATIONAL THERAPY RECOVERY CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NW 140TH MNR
PEMBROKE PINES FL
33028-3011
US

IV. Provider business mailing address

1520 NW 140TH MNR
PEMBROKE PINES FL
33028-3011
US

V. Phone/Fax

Practice location:
  • Phone: 954-830-6838
  • Fax:
Mailing address:
  • Phone: 954-830-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AUDREY Y MORALY
Title or Position: OCCUPATIONAL THERAPIST ASSISTANT
Credential: COTA
Phone: 954-830-6838