Provider Demographics
NPI:1942075122
Name:FUN-ESSENTIAL OCCUPATIONAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:FUN-ESSENTIAL OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBLETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-788-2180
Mailing Address - Street 1:336 SE 37TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6251
Mailing Address - Country:US
Mailing Address - Phone:305-788-2180
Mailing Address - Fax:
Practice Address - Street 1:336 SE 37TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6251
Practice Address - Country:US
Practice Address - Phone:305-788-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center