Provider Demographics
NPI:1760639066
Name:SOUTHERN OCCUPATIONAL THERAPY PRODUCTS INC
Entity Type:Organization
Organization Name:SOUTHERN OCCUPATIONAL THERAPY PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARON
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR, CSFA
Authorized Official - Phone:772-708-3751
Mailing Address - Street 1:690 JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4750
Mailing Address - Country:US
Mailing Address - Phone:772-708-3751
Mailing Address - Fax:772-225-0843
Practice Address - Street 1:690 JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4750
Practice Address - Country:US
Practice Address - Phone:772-708-3751
Practice Address - Fax:772-225-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1145261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy