Provider Demographics
NPI:1437237864
Name:INDIAN RIVER HAND REHABILITATION INC
Entity Type:Organization
Organization Name:INDIAN RIVER HAND REHABILITATION INC
Other - Org Name:INDIAN RIVER HAND AND UPPER EXTREMITY REHABILITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL CHT
Authorized Official - Phone:772-562-6401
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:SUITE E-110
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-562-6401
Mailing Address - Fax:772-562-6011
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E-110
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-562-6401
Practice Address - Fax:772-562-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE587Medicare PIN