Potential Pediatric Occupational Therapy Services, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT10154 Issued in FL

Legal business name

POTENTIAL PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC

Practice address

10161 Brookwood Forest Blvd
Jacksonville, FL 32225-9064

Phone

(904) 254-7569

Fax

(904) 302-6270

NPI assigned

Feb 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Huszcza, MS, OTR/L

Title

Owner

Phone

(904) 254-7569

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1619216215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10161 BROOKWOOD FOREST BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322259064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10161 BROOKWOOD FOREST BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322259064",
            "telephone_number": "904-254-7569",
            "fax_number": "904-302-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTENTIAL PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-04",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "HUSZCZA",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-254-7569",
        "authorized_official_credential": "MS, OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT10154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887015200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.