Healthcare Provider Details

I. General information

NPI: 1619854411
Provider Name (Legal Business Name): MARIPOSA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 MAGNOLIA RESERVE PL
WIMAUMA FL
33598-4074
US

IV. Provider business mailing address

16712 MAGNOLIA RESERVE PL
WIMAUMA FL
33598-4074
US

V. Phone/Fax

Practice location:
  • Phone: 813-503-0169
  • Fax:
Mailing address:
  • Phone: 910-420-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE PEREZ WATSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT
Phone: 813-503-0169