Full Life Mobile Therapy LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

FULL LIFE MOBILE THERAPY LLC

Practice address

3138 Laura LN
Westlake, OH 44145-5524

Phone

(216) 544-1715

NPI assigned

Apr 30, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kwangme Park, OTR/L

Title

Occupational Therapist

Phone

(216) 544-1715

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1295318897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3138 LAURA LN",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441455524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3138 LAURA LN",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441455524",
            "telephone_number": "216-544-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE MOBILE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-30",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "KWANGME",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "216-544-1715",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Westlake, OH
• Providers in Westlake, OH by specialty
• Occupational Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.