Provider Demographics
NPI:1689284168
Name:THERAPEUTIC PLAY OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC PLAY OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:ORTEGA MERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-365-7972
Mailing Address - Street 1:9647 IVORY DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6793
Mailing Address - Country:US
Mailing Address - Phone:813-365-7972
Mailing Address - Fax:
Practice Address - Street 1:9647 IVORY DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6793
Practice Address - Country:US
Practice Address - Phone:813-365-7972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty