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General NPI Number Information
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NPI Number | 1457789596
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Entity Type | Organization
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Legal Business Name | LIFEFORCE PEDIATRIC THERAPY
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 337 SW CHERRYHILL RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6235
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Country | US
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Telephone | 586-206-0837
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Fax |
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Provider Business Mailing Address
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Address Line | 337 SW CHERRYHILL RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6235
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Country | US
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Telephone | 586-206-0837
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHIRLEY A ESSE
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Credential | M.H.M, O.T.R./L
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Telephone | 586-206-0837
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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 | 5201004005
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12838
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License Number State | FL
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