Provider Demographics
NPI:1013171768
Name:JUNCTION OF FUNCTION INC
Entity type:Organization
Organization Name:JUNCTION OF FUNCTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:239-777-4009
Mailing Address - Street 1:2102 PROMONTORY PT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3547
Mailing Address - Country:US
Mailing Address - Phone:239-777-4009
Mailing Address - Fax:972-612-6804
Practice Address - Street 1:2102 PROMONTORY PT
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3547
Practice Address - Country:US
Practice Address - Phone:239-777-4009
Practice Address - Fax:972-612-6804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUNCTION OF FUNCTION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7324225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886525600Medicaid
TX2823296Medicaid