=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326365990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC EXPRESSIONS REHABILITATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2010
-----------------------------------------------------
Last Update Date | 04/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 152 TIGERLILY COURT
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33836-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-430-6299
-----------------------------------------------------
Fax | 863-438-4945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 2410
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-430-6299
-----------------------------------------------------
Fax | 863-438-4345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER/PARTNER/CFO
-----------------------------------------------------
Name | MRS. NOLAJEAN RAYSON-LOCKE
-----------------------------------------------------
Credential | O.T.
-----------------------------------------------------
Telephone | 863-430-6299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------