Southern Magnolia Llc is a
Occupational Therapy Assistant based in Fort Myers, Florida. Southern Magnolia Llc is licensed to practice in * (Not Available) (license number ) and their current practice location is
12856 Banyan Creek Dr # 2, Fort Myers, Florida. It can be reached at their office (for appointments etc.) via phone at
(239) 265-5367.
NPI number for Southern Magnolia Llc is 1114693579 and their current mailing address is 17165 John Morris Rd 291, Ft Myers, Florida. Southern Magnolia Llc
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1114693579.
Healthcare Provider's Profile
| Full Name | Southern Magnolia Llc |
|---|
| Type | Facility |
|---|
| Speciality | Occupational Therapy Assistant |
|---|
| Location | 12856 Banyan Creek Dr # 2, Fort Myers, Florida |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1114693579
- Provider Enumeration Date: 08/17/2021
- Last Update Date: 02/23/2022
Medical Identifiers
Medical identifiers for Southern Magnolia Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114693579 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| 225XP0200X | Occupational Therapist - Pediatrics | (* (Not Available)) | Secondary |
| 2355S0801X | Specialist/technologist - Speech-language Assistant | (* (Not Available)) | Secondary |
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 224Z00000X | Occupational Therapy Assistant | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Southern Magnolia Llc is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Southern Magnolia Llc
17165 John Morris Rd 291,
Ft Myers, FL 33908
Ph: (239) 265-5367 | Southern Magnolia Llc
12856 Banyan Creek Dr # 2,
Fort Myers, FL 33908-3082
Ph: (239) 265-5367 |
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