Provider Demographics
NPI:1114496908
Name:EAST COAST OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:EAST COAST OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-215-7531
Mailing Address - Street 1:3621 SE MICANOPY TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5460
Mailing Address - Country:US
Mailing Address - Phone:772-215-7531
Mailing Address - Fax:
Practice Address - Street 1:3621 SE MICANOPY TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5460
Practice Address - Country:US
Practice Address - Phone:772-215-7531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002870600Medicaid