Healthcare Provider Details

I. General information

NPI: 1629557616
Provider Name (Legal Business Name): CLOSE THE GAP THERAPY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 SCOTT MILL DR
JACKSONVILLE FL
32223-6542
US

IV. Provider business mailing address

2640 SCOTT MILL DR
JACKSONVILLE FL
32223-6542
US

V. Phone/Fax

Practice location:
  • Phone: 904-304-3902
  • Fax: 904-880-8047
Mailing address:
  • Phone: 904-304-3902
  • Fax: 904-880-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13759
License Number StateFL

VIII. Authorized Official

Name: MRS. BETH ANNE KELLEY
Title or Position: OCCUPATIONAL THERAPIST/ OWNER
Credential: OTR/L
Phone: 904-304-3902