Provider Demographics
NPI:1275819013
Name:CELESTIAL SPHERE CONSULTANTS, LLC.
Entity Type:Organization
Organization Name:CELESTIAL SPHERE CONSULTANTS, LLC.
Other - Org Name:BUSINESSDRS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:786-556-1557
Mailing Address - Street 1:5851 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1342
Mailing Address - Country:US
Mailing Address - Phone:786-556-1557
Mailing Address - Fax:
Practice Address - Street 1:5851 SW 188TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1342
Practice Address - Country:US
Practice Address - Phone:786-556-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty