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Organization
POTENTIAL PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Active
Organization
POTENTIAL PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HUSZCZA MS, OTR/L (OWNER)
(904) 254-7569
Entity
Organization
Contact information
Practice address
10161 BROOKWOOD FOREST BLVD, JACKSONVILLE, FL 32225-9064
(904) 254-7569
(904) 302-6270
Mailing address
10161 BROOKWOOD FOREST BLVD, JACKSONVILLE, FL 32225-9064
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT10154
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887015200
—
FL
Enumeration date
02/04/2013
Last updated
02/04/2013
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