Basic Information
| Provider Information | |||||||||
| NPI: | 1922510254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROCK | ||||||||
| FirstName: | CALLEY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ROCK | ||||||||
| OtherFirstName: | CALLEY | ||||||||
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| OtherCredential: | MS, OTR/L | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1239 E NEWPORT CENTER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544443707 | ||||||||
| FaxNumber: | 7546001967 | ||||||||
| Practice Location | |||||||||
| Address1: | 1239 E NEWPORT CENTER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544443707 | ||||||||
| FaxNumber: | 7546001967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2017 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 18688 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.