Healthcare Provider Details

I. General information

NPI: 1760162614
Provider Name (Legal Business Name): AGAPE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 N HIGHWAY 81
PONCE DE LEON FL
32455-6326
US

IV. Provider business mailing address

2000 S BERKSHIRE AVE
SPRINGFIELD MO
65809-3205
US

V. Phone/Fax

Practice location:
  • Phone: 850-598-4045
  • Fax: 850-792-6126
Mailing address:
  • Phone: 850-598-4045
  • Fax: 850-792-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHAUNDA L BRADLEY
Title or Position: OWNER
Credential: OTD
Phone: 850-598-4045