Organization
LYMPHEDEMA CARE CENTER OF NORTH FLORIDA, INC.
Active
Other names
Kids Therapy Korner
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIANELA N/A MARTINEZ OTR/L, CSIT, CLT (OCCUPATIONAL THERAPIST)
(904) 375-0830
Entity
Organization
Contact information
Practice address
8563 ARGYLE BUSINESS LOOP, SUITE #2, JACKSONVILLE, FL 32244-6668
(904) 375-0830
(877) 811-4031
Mailing address
8563 ARGYLE BUSINESS LOOP, SUITE #2, JACKSONVILLE, FL 32244-6668
(904) 375-0830
(877) 811-4031
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
OT11418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003444400
—
FL
05
—
8899886-00FL
—
FL
01
—
CD935A
MEDICARE PTAN
FL
Enumeration date
01/07/2009
Last updated
09/28/2011
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