Provider Demographics
NPI: | 1437576238 |
---|---|
Name: | JAD ESMOND, LLC |
Entity Type: | Organization |
Organization Name: | JAD ESMOND, LLC |
Other - Org Name: | SUCCESS FOR SPECIAL KIDS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR OF CLINICAL SERVICES |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ANITA |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | MAREUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR |
Authorized Official - Phone: | 954-865-3705 |
Mailing Address - Street 1: | 6671 W INDIANTOWN RD |
Mailing Address - Street 2: | SUITE 129 |
Mailing Address - City: | JUPITER |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33458-3991 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-718-9844 |
Mailing Address - Fax: | 561-744-8870 |
Practice Address - Street 1: | 168 SIMS CREEK LN |
Practice Address - Street 2: | |
Practice Address - City: | JUPITER |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33458-7984 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-718-9844 |
Practice Address - Fax: | 561-744-8870 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-19 |
Last Update Date: | 2014-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | OT11518 | 225000000X, 225X00000X, 225XE1200X, 225XF0002X, 225XG0600X, 225XH1200X, 225XL0004X, 225XM0800X, 225XP0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | Group - Multi-Specialty |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | Group - Multi-Specialty |
No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 225X00000X | Other | TAXONOMY CODE |
FL | 1891891297 | Other | NPI # |
FL | 891985200 | Medicaid | |
FL | 010042600 | Medicaid | |
FL | OT11518 | Other | OT LICENSE # |