Healthcare Provider Details

I. General information

NPI: 1013530021
Provider Name (Legal Business Name): ORANGE BLOSSOM THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 SUN N LAKE BLVD STE 103
SEBRING FL
33872-2171
US

IV. Provider business mailing address

4325 SUN N LAKE BLVD STE 103
SEBRING FL
33872-2171
US

V. Phone/Fax

Practice location:
  • Phone: 863-381-2491
  • Fax:
Mailing address:
  • Phone: 863-381-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY WORDEN
Title or Position: OT/MANAGER
Credential: MS OTRL
Phone: 863-381-2491