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General NPI Number Information
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NPI Number | 1619651767
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Entity Type | Organization
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Legal Business Name | MY WELLNESS TEAM LLC
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 4916 N BEND RD
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City | CINCINNATI
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State | OH
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Zip | 45211-2360
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Country | US
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Telephone | 317-750-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 911 E 86TH ST SUITE 103
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City | INDIANAPOLIS
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State | IN
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Zip | 46240
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Country | US
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Telephone | 812-267-2841
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MRS. ANNE ROBERTSON
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Credential |
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Telephone | 812-267-2841
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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