Provider Demographics
NPI:1760162614
Name:AGAPE THERAPY LLC
Entity Type:Organization
Organization Name:AGAPE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:850-598-4045
Mailing Address - Street 1:314 RUCKEL DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1722
Mailing Address - Country:US
Mailing Address - Phone:850-598-4045
Mailing Address - Fax:
Practice Address - Street 1:4390 STATE HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-2422
Practice Address - Country:US
Practice Address - Phone:850-598-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty