MEDICARE: BOMTEMPO WELLNESS 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT17980	OTHER	FL	MARKETPLACE INSURANCE PROGRAMS

General Provider Information

NPI Number	:	1376278630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOMTEMPO WELLNESS LLC

Provider Business Mailing Address
First Line	:	2135 DEER RUN TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1068
Country	:	US
Telephone Number	:	904-832-0667
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 3RD ST S STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6626
Country	:	US
Telephone Number	:	904-776-6596
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	JAMIE LYNN KOREY BOMTEMPO
Credential	:	OTR/L
Telephone Number	:	904-832-0667

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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Directions to “BOMTEMPO WELLNESS LLC ” Practice Location

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