=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073704136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED REHAB SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1427 SW 1ST ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-856-4730
-----------------------------------------------------
Fax | 305-649-9500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 SW 66TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-856-4730
-----------------------------------------------------
Fax | 305-649-9500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAVERIO CUSUMANO
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 305-856-4730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT 7386
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------