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General NPI Number Information
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NPI Number | 1649579350
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Entity Type | Organization
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Legal Business Name | DLC REHAB SERVICES, INC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 4464 WEST 15 AVE
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 786-512-3874
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Fax |
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Provider Business Mailing Address
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Address Line | 4464 W 15TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-3358
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Country | US
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Telephone | 786-512-3874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATIA DE LA CRUZ
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Credential | MS, OTR/L
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Telephone | 786-512-3874
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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 | OT 13643
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License Number State | FL
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