Provider Demographics
NPI:1952979692
Name:TEACHABLE MOMENTS PLLC
Entity Type:Organization
Organization Name:TEACHABLE MOMENTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABETHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OTA13749
Authorized Official - Phone:904-521-7583
Mailing Address - Street 1:6275 CASSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8521
Mailing Address - Country:US
Mailing Address - Phone:352-442-9622
Mailing Address - Fax:
Practice Address - Street 1:6275 CASSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-8521
Practice Address - Country:US
Practice Address - Phone:352-442-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health