Provider Demographics
NPI:1871206045
Name:APOLLO BEACH THERAPY CENTER
Entity type:Organization
Organization Name:APOLLO BEACH THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOVELY
Authorized Official - Middle Name:NOELL
Authorized Official - Last Name:SULTENFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:813-944-7441
Mailing Address - Street 1:6520 RICHIES WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2125
Mailing Address - Country:US
Mailing Address - Phone:813-641-1922
Mailing Address - Fax:
Practice Address - Street 1:6520 RICHIES WAY
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2125
Practice Address - Country:US
Practice Address - Phone:813-944-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty