Organization
BANTA THERAPY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAYLEE BANTA OTD, OTR/L (OWNER)
(321) 446-2742
Entity
Organization
Contact information
Practice address
2565 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 446-2742
Mailing address
2260 BRIDGEPORT CIR, ROCKLEDGE, FL 32955-4344
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014135100
—
FL
05
—
017129500
—
FL
Enumeration date
09/11/2018
Last updated
09/11/2018
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