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General NPI Number Information
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NPI Number | 1235399197
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 8686A E COUNTY ROAD 466
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City | THE VILLAGES
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State | FL
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Zip | 32162-3670
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Country | US
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Telephone | 352-454-3437
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Fax | 352-245-4342
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Provider Business Mailing Address
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Address Line | 8686A E COUNTY ROAD 466
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City | THE VILLAGES
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State | FL
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Zip | 32162-3670
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Country | US
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Telephone | 352-454-3437
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Fax | 352-245-4342
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CAMILLE MAGNUSON
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Credential | COTA/L
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Telephone | 352-454-3437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-8858
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-8946
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License Number State | FL
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