Provider Demographics
NPI:1639724750
Name:OCCUPATIONAL THERAPY RECOVERY CENTER, LLC.
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY RECOVERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MORALY
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:954-830-6838
Mailing Address - Street 1:1520 NW 140TH MNR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3011
Mailing Address - Country:US
Mailing Address - Phone:954-830-6838
Mailing Address - Fax:
Practice Address - Street 1:1520 NW 140TH MNR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3011
Practice Address - Country:US
Practice Address - Phone:954-830-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty