Healthcare Provider Details

I. General information

NPI: 1518716109
Provider Name (Legal Business Name): OT LACTIVIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SMITH ST
CRANSTON RI
02905-4129
US

IV. Provider business mailing address

47 WOOD AVE
BARRINGTON RI
02806-3503
US

V. Phone/Fax

Practice location:
  • Phone: 352-454-8337
  • Fax:
Mailing address:
  • Phone: 352-454-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACAYIA JANAI AUSTIN CUARTAS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L, IBCLC
Phone: 352-454-8337