MEDICARE: ONE PETAL AT A TIME THERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1679334114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE PETAL AT A TIME THERAPY LLC

Provider Business Mailing Address
First Line	:	1801 OBERLIN RD STE 311
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-2998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 OBERLIN RD STE 311
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-2998
Country	:	US
Telephone Number	:	717-971-0529
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PRACTITIONER
Name	:	ASHLEY JONES
Credential	:	LCSW
Telephone Number	:	717-971-0529

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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