Organization
PEDIATRIC THERAPY GROUP
Active
Organization
PEDIATRIC THERAPY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN MARTIN PICKETT (ADMINISTRATOR)
(941) 752-0408
Entity
Organization
Contact information
Practice address
4440B 26TH ST W, BRADENTON, FL 34207-1201
(941) 752-0408
(941) 870-0876
Mailing address
4440B 26TH ST W, BRADENTON, FL 34207-1201
(941) 752-0408
(941) 870-0876
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTA11922
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890133300
—
FL
Enumeration date
12/01/2011
Last updated
12/01/2011
Update your record
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