Provider Demographics
NPI:1871986307
Name:SENIOR THERAPY LLC
Entity type:Organization
Organization Name:SENIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REPICE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:239-777-4028
Mailing Address - Street 1:15574 MARCELLO CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2839
Mailing Address - Country:US
Mailing Address - Phone:239-777-4028
Mailing Address - Fax:
Practice Address - Street 1:13240 TAMIAMI TRL N
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1623
Practice Address - Country:US
Practice Address - Phone:239-777-4028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty