Provider Demographics
NPI:1053740043
Name:RIDGE REHABILITATION
Entity type:Organization
Organization Name:RIDGE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:352-270-8081
Mailing Address - Street 1:5647 N LENA DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4546
Mailing Address - Country:US
Mailing Address - Phone:352-270-8081
Mailing Address - Fax:352-270-8081
Practice Address - Street 1:5647 N LENA DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-4546
Practice Address - Country:US
Practice Address - Phone:352-270-8081
Practice Address - Fax:352-270-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty