Provider Demographics
NPI:1336131788
Name:OCCUPLAY INC
Entity Type:Organization
Organization Name:OCCUPLAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:904-382-9790
Mailing Address - Street 1:100 BOUGANVILLA DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3676
Mailing Address - Country:US
Mailing Address - Phone:904-280-5336
Mailing Address - Fax:904-373-0469
Practice Address - Street 1:1102 A1A N
Practice Address - Street 2:SUITE 105
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4098
Practice Address - Country:US
Practice Address - Phone:904-382-9790
Practice Address - Fax:904-373-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880751500Medicaid
FL880751500Medicaid