=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336131788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPLAY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2005
-----------------------------------------------------
Last Update Date | 04/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1102 A1A N SUITE 105
-----------------------------------------------------
City | PONTE VEDRA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32082-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-382-9790
-----------------------------------------------------
Fax | 904-373-0469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 BOUGANVILLA DR
-----------------------------------------------------
City | PONTE VEDRA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32082-3676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-280-5336
-----------------------------------------------------
Fax | 904-373-0469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. NANCY ANN MARIN
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 904-382-9790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT1278
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------