MEDICARE: OCCUPLAY INC

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	225X00000X	Occupational Therapist	OT1278	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336131788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPLAY INC

Provider Business Mailing Address
First Line	:	100 BOUGANVILLA DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3676
Country	:	US
Telephone Number	:	904-280-5336
Fax Number	:	904-373-0469

Provider Business Practice Location Address
First Line	:	1102 A1A N
Second Line	:	SUITE 105
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4098
Country	:	US
Telephone Number	:	904-382-9790
Fax Number	:	904-373-0469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NANCY ANN MARIN
Credential	:	OTR/L
Telephone Number	:	904-382-9790

Provider Enumeration Date	:	08/20/2005
Last Update Date	:	04/11/2013

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Directions to “OCCUPLAY INC ” Practice Location

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