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General NPI Number Information
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NPI Number | 1912863770
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Entity Type | Organization
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Legal Business Name | E
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Dates
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Enumeration Date | 12/24/2025
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 6203 S JONES RD
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City | TAMPA
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State | FL
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Zip | 33611-5027
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Country | US
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Telephone | 402-658-1543
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Fax | 402-658-1543
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Provider Business Mailing Address
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Address Line | 6203 S JONES RD
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City | TAMPA
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State | FL
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Zip | 33611-5027
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Country | US
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Telephone | 402-658-1543
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Fax | 402-658-1543
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | LAURIE ANN CARLSON
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Credential | MOTR/L
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Telephone | 402-658-1543
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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 |
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License Number State |
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