Provider Demographics
NPI:1861647109
Name:GENESIS REHABILITATION SERVICES
Entity Type:Organization
Organization Name:GENESIS REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA LINDA
Authorized Official - Middle Name:APOSTOL
Authorized Official - Last Name:PUCHERO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:321-305-8389
Mailing Address - Street 1:7260 GREENBORO DR APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1698
Mailing Address - Country:US
Mailing Address - Phone:321-727-0090
Mailing Address - Fax:
Practice Address - Street 1:7260-2 GREENBORO DR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904
Practice Address - Country:US
Practice Address - Phone:321-727-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13166251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care