MEDICARE: OCCUPATIONAL AND REHABILITATION CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1164507422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL AND REHABILITATION CENTER PA

Provider Business Mailing Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:	904-260-3170

Provider Business Practice Location Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:	904-260-3170

Authorized Official
Title or Position	:	ADMINISTRATOR/CHIEF LEGAL OFFICER
Name	:	MS. DARLENE TAN
Credential	:	JD
Telephone Number	:	904-260-3011

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	11/06/2023

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