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Organization
MINDFUL CONNECTIONS THERAPY, CORP.
Active
Organization
MINDFUL CONNECTIONS THERAPY, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GISSELLE CAROLINA VILLANUEVA MS, OTR/L (PRESIDENT)
(786) 246-4987
Entity
Organization
Contact information
Practice address
624 SW 34 AVENUE, HOMESTEAD, FL 33033-7687
(786) 246-4987
Mailing address
624 SW 34 AVENUE, HOMESTEAD, FL 33033-7687
(786) 246-4987
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT15113
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004725700
—
FL
Enumeration date
03/10/2017
Last updated
03/10/2017
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