Provider Demographics
NPI:1093128126
Name:WELLCARE THERAPY GROUP, INC
Entity Type:Organization
Organization Name:WELLCARE THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISETE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARNICER
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPY
Authorized Official - Phone:305-205-8011
Mailing Address - Street 1:1665 W 68TH ST
Mailing Address - Street 2:UNIT 105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4400
Mailing Address - Country:US
Mailing Address - Phone:305-205-8011
Mailing Address - Fax:
Practice Address - Street 1:1665 W 68TH ST
Practice Address - Street 2:UNIT 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4400
Practice Address - Country:US
Practice Address - Phone:305-205-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11330225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty