Healthcare Provider Details

I. General information

NPI: 1962172999
Provider Name (Legal Business Name): HOMEGROWN THERAPY SWFL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 HANCOCK BRIDGE PKWY
CAPE CORAL FL
33990-1459
US

IV. Provider business mailing address

12440 EAGLE PERCH LN
CAPE CORAL FL
33909-3047
US

V. Phone/Fax

Practice location:
  • Phone: 239-478-7059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANIELLE CRAIG
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 239-292-1832