Provider Demographics
NPI:1083921316
Name:THELUSMA, SACHA ANNA GABRIELLA
Entity Type:Individual
Prefix:
First Name:SACHA
Middle Name:ANNA GABRIELLA
Last Name:THELUSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 CURRY CIR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1579
Mailing Address - Country:US
Mailing Address - Phone:954-213-3117
Mailing Address - Fax:
Practice Address - Street 1:6950 CURRY CIR
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-1579
Practice Address - Country:US
Practice Address - Phone:954-213-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant