Healthcare Provider Details

I. General information

NPI: 1649986647
Provider Name (Legal Business Name): FUNSHINE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 LUCERNE DR
MOUNT DORA FL
32757-3639
US

IV. Provider business mailing address

1175 LUCERNE DR
MOUNT DORA FL
32757-3639
US

V. Phone/Fax

Practice location:
  • Phone: 407-506-6705
  • Fax: 407-988-1514
Mailing address:
  • Phone: 407-506-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA NEWTON
Title or Position: OCCUPATIONAL THERAPIST
Credential: MHS, OT/L
Phone: 407-506-6705