Provider Demographics
NPI:1124609854
Name:SUNDBERG, TRISHA SAMANTHA (OTR/L)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:SAMANTHA
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 LYONS PARK DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8712
Mailing Address - Country:US
Mailing Address - Phone:954-330-8068
Mailing Address - Fax:
Practice Address - Street 1:7015 BERACASA WAY STE 102
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3453
Practice Address - Country:US
Practice Address - Phone:561-939-2033
Practice Address - Fax:561-939-2037
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist