MEDICARE: EXCEL TO ACHIEVE OT

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	:	1942900790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL TO ACHIEVE OT

Provider Business Mailing Address
First Line	:	3213 MONTROSE CIR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1828
Country	:	US
Telephone Number	:	276-608-8807
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 MONTROSE CIR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1828
Country	:	US
Telephone Number	:	276-608-8807
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	SAVANNAH COFFEY
Credential	:
Telephone Number	:	276-608-8075

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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Directions to “EXCEL TO ACHIEVE OT ” Practice Location

Language	Start Address	Practice Location

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