MEDICARE: WONDERWAY THERAPIES 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	:	1740882091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDERWAY THERAPIES LLC

Provider Business Mailing Address
First Line	:	11843 W CAMINO VIVAZ
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-5043
Country	:	US
Telephone Number	:	623-512-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	11843 W CAMINO VIVAZ
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-5043
Country	:	US
Telephone Number	:	623-512-1883
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/OWNER
Name	:	JESSICA REINHARDT
Credential	:	OTR/L
Telephone Number	:	623-512-1883

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “WONDERWAY THERAPIES LLC ” Practice Location

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