MEDICARE: RISE PEDIATRIC THERAPY-REACHING INDIVIDUALS SOCIALLY AND EMOTIONAL

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1184462145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE PEDIATRIC THERAPY-REACHING INDIVIDUALS SOCIALLY AND EMOTIONAL

Provider Business Mailing Address
First Line	:	1626 LUDLOW RD
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-6622
Country	:	US
Telephone Number	:	978-855-8534
Fax Number	:

Provider Business Practice Location Address
First Line	:	4680 CARDINAL WAY STE 203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-6675
Country	:	US
Telephone Number	:	978-855-8534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERTA MCCALL
Credential	:
Telephone Number	:	978-855-8534

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	02/09/2026

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