Organization
BACK 2 BASICS OT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOLINA BRAININ-MATTOS OTR/L (OWNER/PRESIDENT)
(407) 376-2592
Entity
Organization
Contact information
Practice address
134 HONORS WAY, WINTER SPRINGS, FL 32708-6352
(407) 376-2592
(407) 369-4221
Mailing address
134 HONORS WAY, WINTER SPRINGS, FL 32708-6352
(407) 376-2592
(407) 369-4221
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT14072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043503485
—
FL
Enumeration date
07/05/2018
Last updated
09/25/2018
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