Healthcare Provider Details

I. General information

NPI: 1558937870
Provider Name (Legal Business Name): FUNCTIONAL HOME TRANSFORMATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6247 BUSHNELL DR
NEW KENT VA
23124-3035
US

IV. Provider business mailing address

6247 BUSHNELL DR
NEW KENT VA
23124-3035
US

V. Phone/Fax

Practice location:
  • Phone: 804-304-0837
  • Fax: 804-302-6496
Mailing address:
  • Phone: 804-304-0837
  • Fax: 804-302-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TOMEEKER BOOTH GARY
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential:
Phone: 804-304-0837