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General NPI Number Information
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NPI Number | 1447103551
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Entity Type | Organization
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Legal Business Name | OCEAN TIDE THERAPY, LLC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 8415 VIA SERENA
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City | BOCA RATON
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State | FL
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Zip | 33433-2241
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Country | US
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Telephone | 954-418-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 VIA SERENA
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City | BOCA RATON
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State | FL
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Zip | 33433-2241
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Country | US
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Telephone | 954-418-2244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEFANIE ALYSSA IRMEN
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Credential | OTRL
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Telephone | 847-917-1465
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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 |
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License Number State |
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