Provider Demographics
NPI:1558747030
Name:OCEANSIDE OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:OCEANSIDE OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:772-497-4186
Mailing Address - Street 1:2380 NW PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9246
Mailing Address - Country:US
Mailing Address - Phone:772-497-4186
Mailing Address - Fax:772-692-7253
Practice Address - Street 1:2380 NW PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9246
Practice Address - Country:US
Practice Address - Phone:772-497-4186
Practice Address - Fax:772-692-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty