Provider Demographics
NPI:1194494476
Name:HAND CENTER OF THE EMERALD COAST, LLC.
Entity type:Organization
Organization Name:HAND CENTER OF THE EMERALD COAST, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:850-543-2163
Mailing Address - Street 1:26 RACETRACK RD NW STE E
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1640
Mailing Address - Country:US
Mailing Address - Phone:850-543-2163
Mailing Address - Fax:
Practice Address - Street 1:26 RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1640
Practice Address - Country:US
Practice Address - Phone:850-543-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty