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General NPI Number Information
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NPI Number | 1770126443
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Entity Type | Organization
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Legal Business Name | OCEAN OF CHANGE THERAPY SERVICES LLC
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 10907 S EASTERN AVE STE 100
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City | HENDERSON
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State | NV
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Zip | 89052-5863
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Country | US
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Telephone | 702-867-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 ANTHEM VILLAGE DR STE E380
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City | HENDERSON
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State | NV
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Zip | 89052-5505
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Country | US
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Telephone | 702-867-4266
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Fax | 702-867-4261
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MISS BRYNN N BUTZMAN
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Credential | OTD, OTR/L
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Telephone | 408-813-1762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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