Provider Demographics
NPI:1164962528
Name:HELENA WISTON, LLC
Entity Type:Organization
Organization Name:HELENA WISTON, LLC
Other - Org Name:FUNCTION TIME THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-756-4254
Mailing Address - Street 1:11671 ISLAND LAKES LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6802
Mailing Address - Country:US
Mailing Address - Phone:561-756-4254
Mailing Address - Fax:
Practice Address - Street 1:11671 ISLAND LAKES LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6802
Practice Address - Country:US
Practice Address - Phone:561-756-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-6226225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883426100Medicaid
FL003729800Medicaid