MEDICARE: ATLANTIS THERAPY SERVICES INC.

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	OT 5265	FL

General Provider Information

NPI Number	:	1629317672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIS THERAPY SERVICES INC.

Provider Business Mailing Address
First Line	:	5703 RED BUG LAKE RD
Second Line	:	SUITE 518
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	407-629-0444
Fax Number	:	877-260-0444

Provider Business Practice Location Address
First Line	:	5703 RED BUG LAKE RD
Second Line	:	SUITE 518
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4969
Country	:	US
Telephone Number	:	407-629-0444
Fax Number	:	877-260-0444

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. RENAE FENNELL
Credential	:	OTL
Telephone Number	:	407-629-0444

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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