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General NPI Number Information
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NPI Number | 1316286255
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Entity Type | Organization
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Legal Business Name | ON SITE THERAPY LLC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1910 BUFORD BLVD STE A
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4668
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Country | US
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Telephone | 850-339-8145
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Fax | 850-597-7062
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Provider Business Mailing Address
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Address Line | 3409 EDGEMONT TRL
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3650
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Country | US
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Telephone | 850-339-8145
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Fax | 850-597-7062
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES R LETCHWORTH
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Credential | OT CLT
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Telephone | 850-339-8145
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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 | OT7931
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License Number State | FL
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