Provider Demographics
NPI:1467208868
Name:HOMEBODY THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:HOMEBODY THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:843-503-4461
Mailing Address - Street 1:285 OLD VILLAGE CENTER CIR UNIT 5203
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5817
Mailing Address - Country:US
Mailing Address - Phone:843-503-4461
Mailing Address - Fax:
Practice Address - Street 1:285 OLD VILLAGE CENTER CIR UNIT 5203
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5817
Practice Address - Country:US
Practice Address - Phone:843-503-4461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty