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General NPI Number Information
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NPI Number | 1487891859
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA CARE CENTER OF NORTH FLORIDA, INC.
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 8563 ARGYLE BUSINESS LOOP SUITE #2
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6668
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Country | US
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Telephone | 904-375-0830
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Fax | 877-811-4031
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Provider Business Mailing Address
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Address Line | 8563 ARGYLE BUSINESS LOOP SUITE #2
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6668
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Country | US
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Telephone | 904-375-0830
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Fax | 877-811-4031
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MS. MARIANELA N/A MARTINEZ
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Credential | OTR/L, CSIT, CLT
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Telephone | 904-375-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | OT11418
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License Number State | FL
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