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Organization

SOUTHERN MAGNOLIA LLC

Active
Other names
Southern Magnolia LLC
Organization subpart
No

Provider details

NPI number
Authorized official
JAMIE GEERKEN COTA (OWNER)
(239) 265-5367
Entity
Organization

Contact information

Practice address
12856 BANYAN CREEK DR # 2, FORT MYERS, FL 33908-3082
(239) 265-5367
Mailing address
17165 JOHN MORRIS RD 291, FT MYERS, FL 33908
(239) 265-5367

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
225X00000X
Occupational Therapist
225XP0200X
Pediatric Occupational Therapist
2355S0801X
Speech-Language Assistant
235Z00000X
Speech-Language Pathologist

Other

Enumeration date
08/17/2021
Last updated
02/23/2022
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