MEDICARE: CANOPY OCCUPATIONAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XE0001X	Environmental Modification Occupational Therapist
2	225XH1200X	Hand Occupational Therapist
3	225XP0019X	Physical Rehabilitation Occupational Therapist
4	225XN1300X	Neurorehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1194677930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANOPY OCCUPATIONAL THERAPY

Provider Business Mailing Address
First Line	:	4908 KEY LIME DR UNIT 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3270
Country	:	US
Telephone Number	:	305-409-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	4908 KEY LIME DR UNIT 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3270
Country	:	US
Telephone Number	:	305-409-9376
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KELLEY MARTIN
Credential	:	OTR/L
Telephone Number	:	305-409-9376

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	03/25/2026

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