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General NPI Number Information
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NPI Number | 1477923548
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Entity Type | Organization
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Legal Business Name | BAY AREA RESTORATIVE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 9405 BELLHAVEN ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-4958
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Country | US
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Telephone | 813-843-8732
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292761
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City | TAMPA
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State | FL
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Zip | 33687-2761
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Country | US
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Telephone | 813-843-8732
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ROSE E BEAUGE
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Credential | MSOTR/L
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Telephone | 813-843-8732
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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 | 16491
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License Number State | FL
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