MEDICARE: COMING HOME HOLISTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1104578863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMING HOME HOLISTIC LLC

Provider Business Mailing Address
First Line	:	8435 LANDER ST APT 4C
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-2016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14707 SPEER LAKE DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-8870
Country	:	US
Telephone Number	:	714-515-9621
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BHAKTI REDDY
Credential	:	OTR/L
Telephone Number	:	714-515-9621

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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Directions to “COMING HOME HOLISTIC LLC ” Practice Location

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