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General NPI Number Information
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NPI Number | 1043602741
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL THERAPY & WELLNESS CENTERS OF AMERICA, INC.
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 11820 MIRAMAR PKWY STE 110
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City | MIRAMAR
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State | FL
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Zip | 33025-5816
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Country | US
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Telephone | 954-870-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 11820 MIRAMAR PKWY STE 110
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City | MIRAMAR
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State | FL
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Zip | 33025-5816
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Country | US
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Telephone | 954-870-0050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT JASON MULLANEY
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Credential | OTR/L, MBA-HSA, DBA
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Telephone | 954-870-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT10332
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | OT10332
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License Number State | FL
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