Healthcare Provider Details

I. General information

NPI: 1982306064
Provider Name (Legal Business Name): OPTIMAL THERAPY & CUSTOM CELEBRATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PAWTUCKET AVE
RUMFORD RI
02916-1427
US

IV. Provider business mailing address

63 BELFIELD DR
JOHNSTON RI
02919-1801
US

V. Phone/Fax

Practice location:
  • Phone: 401-301-1014
  • Fax:
Mailing address:
  • Phone: 401-301-1014
  • 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 Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. PRISCILLA F NOVA
Title or Position: OWNER
Credential: OT/L
Phone: 401-301-1014