Provider Demographics
NPI:1184462145
Name:RISE PEDIATRIC THERAPY-REACHING INDIVIDUALS SOCIALLY AND EMOTIONALLY
Entity type:Organization
Organization Name:RISE PEDIATRIC THERAPY-REACHING INDIVIDUALS SOCIALLY AND EMOTIONALLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-855-8534
Mailing Address - Street 1:1626 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6622
Mailing Address - Country:US
Mailing Address - Phone:978-855-8534
Mailing Address - Fax:
Practice Address - Street 1:4680 CARDINAL WAY STE 203
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6675
Practice Address - Country:US
Practice Address - Phone:978-855-8534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty