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General NPI Number Information
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NPI Number | 1376278630
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Entity Type | Organization
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Legal Business Name | BOMTEMPO WELLNESS LLC
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 636 3RD ST S STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32250-6626
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Country | US
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Telephone | 904-776-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 DEER RUN TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32246-1068
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Country | US
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Telephone | 904-832-0667
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JAMIE LYNN KOREY BOMTEMPO
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Credential | OTR/L
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Telephone | 904-832-0667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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