Organization
FUNCTIONAL IMPROVEMENTS THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY LEE BLAKE OT (OWNER)
(772) 532-0853
Entity
Organization
Contact information
Practice address
12840 83RD AVE, ROSELAND, FL 32957
(772) 532-0833
(772) 571-6190
Mailing address
PO BOX 1175, ROSELAND, FL 32957-1175
(772) 532-0833
(772) 571-6190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT2648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006673400
—
FL
Enumeration date
12/07/2012
Last updated
12/07/2012
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