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General NPI Number Information
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NPI Number | 1487234068
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Entity Type | Organization
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Legal Business Name | FORWARD LIVING THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 4600 SUMMERLIN RD # C-2272
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City | FORT MYERS
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State | FL
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Zip | 33919-3005
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Country | US
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Telephone | 239-266-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 SUMMERLIN RD # C-2272
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City | FORT MYERS
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State | FL
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Zip | 33919-3005
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Country | US
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Telephone | 239-266-5362
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT/OWNER
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Name | DR. JESSICA A CHAPMAN
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Credential | OTD, OTR/L
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Telephone | 239-266-5362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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