Provider Demographics
NPI:1750003935
Name:FUNCTIONAL FOUNDATIONS LLC
Entity type:Organization
Organization Name:FUNCTIONAL FOUNDATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:419-367-0503
Mailing Address - Street 1:15996 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9583
Mailing Address - Country:US
Mailing Address - Phone:419-367-0503
Mailing Address - Fax:
Practice Address - Street 1:15996 CHAMBERLAIN RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9583
Practice Address - Country:US
Practice Address - Phone:419-367-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty