Provider Demographics
NPI:1770968174
Name:TRUE BLUE PEDS THERAPY
Entity type:Organization
Organization Name:TRUE BLUE PEDS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OTR/L MGR OCC. THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DHARINI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVERI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:813-643-4591
Mailing Address - Street 1:1810 FLAT BRANCH CT.,
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594
Mailing Address - Country:US
Mailing Address - Phone:813-486-1718
Mailing Address - Fax:813-643-4591
Practice Address - Street 1:1097 E. BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-486-1718
Practice Address - Fax:813-643-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty