=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568877967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JAMES BREEN JR. OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2014
-----------------------------------------------------
Last Update Date | 06/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 CORPORATE DR #280 CENTRA HEALTHCARE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-535-0076
-----------------------------------------------------
Fax | 800-436-1011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 CORPORATE DR #280 CENTRA HEALTHCARE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-535-0076
-----------------------------------------------------
Fax | 800-436-1011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC008902
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------