Organization
GENESIS REHAB SERVICES
Active
Parent organization
GENESIS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS
Authorized official
MARY ELLEN MATHE (COTA)
(904) 310-9411
Entity
Organization
Contact information
Practice address
552 SPANISH WAY W, FERNANDINA BEACH, FL 32034-9244
(904) 310-9411
Mailing address
552 SPANISH WAY W, FERNANDINA BEACH, FL 32034-9244
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11456
FL
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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