Healthcare Provider Details

I. General information

NPI: 1477460160
Provider Name (Legal Business Name): FUNCTIONAL LIVING THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E PALMETTO ST
PALATKA FL
32177-4793
US

IV. Provider business mailing address

503 E PALMETTO ST
PALATKA FL
32177-4793
US

V. Phone/Fax

Practice location:
  • Phone: 386-695-8046
  • 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

VIII. Authorized Official

Name: MIKAILA JONES
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 386-695-8046