Provider Demographics
NPI:1922370261
Name:PROVISION REHAB INC
Entity Type:Organization
Organization Name:PROVISION REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN-RAY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:561-352-4939
Mailing Address - Street 1:3610 OLD LIGHTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8843
Mailing Address - Country:US
Mailing Address - Phone:561-352-4939
Mailing Address - Fax:561-333-0994
Practice Address - Street 1:3610 OLD LIGHTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8843
Practice Address - Country:US
Practice Address - Phone:561-352-4939
Practice Address - Fax:561-333-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty