Basic Information
| Provider Information | |||||||||
| NPI: | 1184388043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GOOD GOOD LIFE OCCUPATIONAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 CONSERVATION PL APT 203 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329348770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215436939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3250 CONSERVATION PL APT 203 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329348770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215436939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | ALISON | ||||||||
| AuthorizedOfficialMiddleName: | LINDSEY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3215436939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OTD, OTR/L | ||||||||
| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.