Healthcare Provider Details

I. General information

NPI: 1114785227
Provider Name (Legal Business Name): MOTIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 HUNTERS PARK LN
ORLANDO FL
32837-7614
US

IV. Provider business mailing address

4347 HUNTERS PARK LN
ORLANDO FL
32837-7614
US

V. Phone/Fax

Practice location:
  • Phone: 407-952-5594
  • Fax:
Mailing address:
  • Phone: 407-952-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. BETTY OSPINA
Title or Position: ADMINISTRATOR
Credential: MPA
Phone: 407-952-5594