Provider Demographics
NPI:1407541287
Name:COMPASS VISION THERAPY
Entity Type:Organization
Organization Name:COMPASS VISION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOUNTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLVT
Authorized Official - Phone:813-727-5747
Mailing Address - Street 1:2026 SE 14TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3885
Mailing Address - Country:US
Mailing Address - Phone:813-727-5747
Mailing Address - Fax:
Practice Address - Street 1:2026 SE 14TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3885
Practice Address - Country:US
Practice Address - Phone:813-727-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty