Functional Therapy LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1249 Issued in MS

Legal business name

FUNCTIONAL THERAPY LLC

Practice address

311 N Main St
Picayune, MS 39466-3313

Phone

(601) 799-4065

Fax

(601) 620-4117

NPI assigned

Jul 25, 2011

Last updated

Dec 31, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacey S Vollenweider, OTR/LNPI 1417245648

Title

Owner

Phone

(228) 216-9996

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacey S Vollenweider, OTR/L

  • Occupational Therapist
  • Picayune, MS
  • NPI 1417245648
  NPD (past) Authorized official

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1417235490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7533 CROOKED STICK DR",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253895",
            "telephone_number": "228-255-8031",
            "fax_number": "601-620-4117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N MAIN ST",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663313",
            "telephone_number": "601-799-4065",
            "fax_number": "601-620-4117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-25",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "VOLLENWEIDER",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-216-9996",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01458505",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Picayune, MS
• Providers in Picayune, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; 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.