Healthcare Provider Details

I. General information

NPI: 1770126443
Provider Name (Legal Business Name): OCEAN OF CHANGE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10907 S EASTERN AVE STE 100
HENDERSON NV
89052-5863
US

IV. Provider business mailing address

2505 ANTHEM VILLAGE DR STE E380
HENDERSON NV
89052-5505
US

V. Phone/Fax

Practice location:
  • Phone: 702-867-4266
  • Fax:
Mailing address:
  • Phone: 702-867-4266
  • Fax: 702-867-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS BRYNN N BUTZMAN
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 408-813-1762