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General NPI Number Information
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NPI Number | 1578346797
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Entity Type | Organization
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Legal Business Name | PINE ISLAND WELLNESS AT HOME LLC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 4480 STRINGFELLOW RD UNIT 86
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City | SAINT JAMES CITY
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State | FL
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Zip | 33956-2414
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Country | US
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Telephone | 941-202-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 PINETREE BLVD
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City | SAINT JAMES CITY
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State | FL
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Zip | 33956-2429
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Country | US
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Telephone | 239-940-0767
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER - FOUNDER
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Name | JODY FRANKE
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Credential | COTA-L, CAPS
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Telephone | 239-940-0767
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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