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General NPI Number Information
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NPI Number | 1285153429
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPLAY
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9278 LEGARE ST
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City | BOCA RATON
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State | FL
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Zip | 33434-5905
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Country | US
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Telephone | 954-296-5085
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Fax |
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Provider Business Mailing Address
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Address Line | 9278 LEGARE ST
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City | BOCA RATON
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State | FL
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Zip | 33434-5905
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Country | US
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Telephone | 954-296-5085
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. RACHEL A KHALIFA
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Credential | OTR/L
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Telephone | 954-296-5085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | OT14224
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License Number State | FL
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