Provider Demographics
NPI:1043602741
Name:OCCUPATIONAL THERAPY & WELLNESS CENTERS OF AMERICA, INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY & WELLNESS CENTERS OF AMERICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, MBA-HSA, DBA
Authorized Official - Phone:954-870-0050
Mailing Address - Street 1:11820 MIRAMAR PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5816
Mailing Address - Country:US
Mailing Address - Phone:954-870-0050
Mailing Address - Fax:
Practice Address - Street 1:11820 MIRAMAR PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5816
Practice Address - Country:US
Practice Address - Phone:954-870-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10332261QM1300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation