Healthcare Provider Details

I. General information

NPI: 1588483473
Provider Name (Legal Business Name): OPAL SKY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GRANDE BERWICK CT
DAYTONA BEACH FL
32124-2100
US

IV. Provider business mailing address

121 GRANDE BERWICK CT
DAYTONA BEACH FL
32124-2100
US

V. Phone/Fax

Practice location:
  • Phone: 352-600-4644
  • Fax: 386-777-0442
Mailing address:
  • Phone: 352-600-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SEILER-ADAMS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 561-573-2983