Back 2 Basics OT, LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT14072 Issued in FL

Legal business name

BACK 2 BASICS OT, LLC

Practice address

134 Honors Way
Winter Springs, FL 32708-6352

Phone

(407) 376-2592

Fax

(407) 369-4221

NPI assigned

Jul 5, 2018

Organization subpart

No

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

Authorized official

Name

Solina Brainin-Mattos, OTR/L

Title

Owner/President

Phone

(407) 376-2592

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1780170498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 HONORS WAY",
            "city": "WINTER SPRINGS",
            "state": "FL",
            "postal_code": "327086352",
            "telephone_number": "407-376-2592",
            "fax_number": "407-369-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 HONORS WAY",
            "city": "WINTER SPRINGS",
            "state": "FL",
            "postal_code": "327086352",
            "telephone_number": "407-376-2592",
            "fax_number": "407-369-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK 2 BASICS OT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-05",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "BRAININ-MATTOS",
        "authorized_official_first_name": "SOLINA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "407-376-2592",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "OT14072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043503485",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.