Provider Demographics
NPI:1982306064
Name:OPTIMAL THERAPY & CUSTOM CELEBRATIONS LLC
Entity Type:Organization
Organization Name:OPTIMAL THERAPY & CUSTOM CELEBRATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:NOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:401-301-1014
Mailing Address - Street 1:63 BELFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-1801
Mailing Address - Country:US
Mailing Address - Phone:401-301-1014
Mailing Address - Fax:
Practice Address - Street 1:1240 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1427
Practice Address - Country:US
Practice Address - Phone:401-301-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty