Provider Demographics
NPI:1619497104
Name:ARAS OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:ARAS OCCUPATIONAL THERAPY PLLC
Other - Org Name:THE NEIGHBORHOOD OT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHAEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHBURN-OLOMO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:347-749-2167
Mailing Address - Street 1:315 TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32352-6995
Mailing Address - Country:US
Mailing Address - Phone:347-749-2167
Mailing Address - Fax:347-710-1292
Practice Address - Street 1:315 TILLMAN RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32352-6995
Practice Address - Country:US
Practice Address - Phone:347-749-2167
Practice Address - Fax:347-710-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty