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General NPI Number Information
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NPI Number | 1093128126
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Entity Type | Organization
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Legal Business Name | WELLCARE THERAPY GROUP, INC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1665 W 68TH ST UNIT 105
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City | HIALEAH
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State | FL
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Zip | 33014-4400
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Country | US
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Telephone | 305-205-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 W 68TH ST UNIT 105
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City | HIALEAH
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State | FL
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Zip | 33014-4400
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Country | US
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Telephone | 305-205-8011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISETE B CARNICER
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Credential | OCCUPATIONAL THERAPY
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Telephone | 305-205-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTA11330
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License Number State | FL
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