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General NPI Number Information
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NPI Number | 1992250518
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Entity Type | Organization
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Legal Business Name | CARROUSEL THERAPY CENTER CORPORATION
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 2520 SAND MINE RD
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City | DAVENPORT
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State | FL
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Zip | 33897-3402
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Country | US
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Telephone | 863-576-1900
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Fax | 888-477-7678
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Provider Business Mailing Address
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Address Line | 3201 BUDINGER AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-7203
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Country | US
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Telephone | 407-891-3054
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Fax | 888-477-7678
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DALIS MINEIRA RIVERA
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Credential | OTR/L
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Telephone | 407-891-3054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | OT1601
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License Number State | FL
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