Provider Demographics
NPI:1770126443
Name:OCEAN OF CHANGE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:OCEAN OF CHANGE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRYNN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:408-813-1762
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR STE E380
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-867-4266
Mailing Address - Fax:702-867-4261
Practice Address - Street 1:10907 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5863
Practice Address - Country:US
Practice Address - Phone:702-867-4266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty