Provider Demographics
NPI:1730290792
Name:INDEPENDENCE INN INC
Entity Type:Organization
Organization Name:INDEPENDENCE INN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:352-688-8583
Mailing Address - Street 1:8356 ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-6016
Mailing Address - Country:US
Mailing Address - Phone:352-688-8583
Mailing Address - Fax:352-796-3323
Practice Address - Street 1:8356 ELDRIDGE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-6016
Practice Address - Country:US
Practice Address - Phone:352-688-8583
Practice Address - Fax:352-796-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1702Medicare PIN