Provider Demographics
NPI:1376278630
Name:BOMTEMPO WELLNESS LLC
Entity Type:Organization
Organization Name:BOMTEMPO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN KOREY
Authorized Official - Last Name:BOMTEMPO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:904-832-0667
Mailing Address - Street 1:2135 DEER RUN TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1068
Mailing Address - Country:US
Mailing Address - Phone:904-832-0667
Mailing Address - Fax:
Practice Address - Street 1:636 3RD ST S STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-6626
Practice Address - Country:US
Practice Address - Phone:904-776-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT17980OtherMARKETPLACE INSURANCE PROGRAMS