Provider Demographics
NPI:1669627394
Name:FUNCTIONAL THERAPY SOLUTIONS LLC
Entity Type:Organization
Organization Name:FUNCTIONAL THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DUANE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:440-781-8136
Mailing Address - Street 1:4980 CORKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3157
Mailing Address - Country:US
Mailing Address - Phone:440-781-8136
Mailing Address - Fax:
Practice Address - Street 1:4980 CORKWOOD DR
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3157
Practice Address - Country:US
Practice Address - Phone:440-781-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty