Organization
FUNDAMENTALS PEDIATRIC THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOVA FUND MS, OTR/L (MEMBER/MANAGER)
(347) 525-4839
Entity
Organization
Contact information
Practice address
4140 N MERIDIAN AVE, #1, MIAMI BEACH, FL 33140-3321
(347) 525-4839
Mailing address
4140 N MERIDIAN AVE, #1, MIAMI BEACH, FL 33140-3321
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT13579
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000913500
—
FL
Enumeration date
04/14/2014
Last updated
04/14/2014
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