Provider Demographics
NPI: | 1932741659 |
---|---|
Name: | FUNCTIONALITY FOR LIFE, LLC |
Entity Type: | Organization |
Organization Name: | FUNCTIONALITY FOR LIFE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TREVINO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR/L |
Authorized Official - Phone: | 813-442-1204 |
Mailing Address - Street 1: | 1234 KATAHDIN CT |
Mailing Address - Street 2: | |
Mailing Address - City: | WESLEY CHAPEL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33543-6860 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-442-1204 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1234 KATAHDIN CT |
Practice Address - Street 2: | |
Practice Address - City: | WESLEY CHAPEL |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33543-6860 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-442-1204 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-14 |
Last Update Date: | 2021-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | Group - Multi-Specialty |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | Group - Multi-Specialty |
No | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | Group - Multi-Specialty |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |