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General NPI Number Information
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NPI Number | 1275819013
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Entity Type | Organization
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Legal Business Name | CELESTIAL SPHERE CONSULTANTS, LLC.
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 5851 SW 188TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33332-1342
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Country | US
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Telephone | 786-556-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 5851 SW 188TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33332-1342
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Country | US
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Telephone | 786-556-1557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/THERAPIST
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Name | DR. ROBERT JASON MULLANEY JR.
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Credential | OTR/L
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Telephone | 786-556-1557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT10332
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License Number State | FL
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