Healthcare Provider Details

I. General information

NPI: 1144975186
Provider Name (Legal Business Name): ROOTED IN FUNCTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 1ST AVE
RICHMOND VA
23222-3223
US

IV. Provider business mailing address

3104 1ST AVE
RICHMOND VA
23222-3223
US

V. Phone/Fax

Practice location:
  • Phone: 763-607-2294
  • Fax:
Mailing address:
  • Phone: 763-607-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONI C WATLING
Title or Position: FOUNDER
Credential: OTD, MOT, OTR/L
Phone: 763-607-2294