Provider Demographics
NPI:1184466690
Name:WELLNESS OASIS THERAPY LLC
Entity type:Organization
Organization Name:WELLNESS OASIS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:239-214-4128
Mailing Address - Street 1:2119 NE 36TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-3245
Mailing Address - Country:US
Mailing Address - Phone:239-214-4128
Mailing Address - Fax:
Practice Address - Street 1:2119 NE 36TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-3245
Practice Address - Country:US
Practice Address - Phone:239-214-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center