Provider Demographics
NPI:1205380797
Name:PALM BEACH CHILDREN'S THERAPY, LLC
Entity Type:Organization
Organization Name:PALM BEACH CHILDREN'S THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:HULETT
Authorized Official - Last Name:NEHEMIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT OTR/L
Authorized Official - Phone:561-906-8257
Mailing Address - Street 1:156 GREGORY PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-5028
Mailing Address - Country:US
Mailing Address - Phone:561-906-8257
Mailing Address - Fax:561-420-0228
Practice Address - Street 1:156 GREGORY PL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-5028
Practice Address - Country:US
Practice Address - Phone:561-906-8257
Practice Address - Fax:561-420-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003185300Medicaid