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General NPI Number Information
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NPI Number | 1992101117
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Entity Type | Organization
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Legal Business Name | NELSON PEDIATRIC THERAPY
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Dates
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Enumeration Date | 11/16/2014
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Last Update Date | 11/16/2014
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Provider Practice Location Address
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Address Line | 6790 N WATERWAY DR
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City | MIAMI
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State | FL
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Zip | 33155-3855
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Country | US
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Telephone | 303-918-1156
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Fax | 305-602-5916
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Provider Business Mailing Address
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Address Line | 6790 N WATERWAY DR
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City | MIAMI
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State | FL
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Zip | 33155-3855
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Country | US
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Telephone | 303-918-1156
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Fax | 305-602-5916
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MS. SHAUNA J NELSON
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Credential | MS, OTR/L
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Telephone | 303-918-1156
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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 | OT16533
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License Number State | FL
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