MEDICARE: SWEET POTENTIAL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT13786	FL

General Provider Information

NPI Number	:	1265910392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET POTENTIAL, LLC

Provider Business Mailing Address
First Line	:	1981 HIDDEN SPRINGS DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2347
Country	:	US
Telephone Number	:	305-283-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1981 HIDDEN SPRINGS DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2347
Country	:	US
Telephone Number	:	305-283-5050
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER/OWNER
Name	:	TRACY VEGA
Credential	:	M.S., OTR/L
Telephone Number	:	305-283-5050

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	05/03/2022

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Directions to “SWEET POTENTIAL, LLC ” Practice Location

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