MEDICARE: OCEAN TIDE THERAPY, LLC

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

General Provider Information

NPI Number	:	1447103551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN TIDE THERAPY, LLC

Provider Business Mailing Address
First Line	:	8415 VIA SERENA
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2241
Country	:	US
Telephone Number	:	954-418-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 VIA SERENA
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2241
Country	:	US
Telephone Number	:	954-418-2244
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEFANIE ALYSSA IRMEN
Credential	:	OTRL
Telephone Number	:	847-917-1465

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	04/06/2026

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