NPIMap

Organization Active NPI

Lymphedema Care Center of North Florida, Inc.

Doing business as Kids Therapy Korner

  • Preferred Provider Organization
  • Jacksonville, FL
National Provider Identifier
1487891859
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
OT11418 Issued in FL
Legal business name
LYMPHEDEMA CARE CENTER OF NORTH FLORIDA, INC.
Doing business as
Kids Therapy Korner
Practice address
8563 Argyle Business Loop
Suite #2
Jacksonville, FL 32244-6668
Phone
(904) 375-0830
Fax
(877) 811-4031
NPI assigned
Jan 7, 2009
Last updated
Sep 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Ms. Marianela N/a Martinez, OTR/L, CSIT, CLTNPI 1306869193
Title
Occupational Therapist
Phone
(904) 375-0830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X OT11418 FL Primary

Addresses

Primary practice location

8563 Argyle Business Loop
Suite #2
Jacksonville, FL 32244-6668

Mailing address

8563 Argyle Business Loop
Suite #2
Jacksonville, FL 32244-6668
Phone (904) 375-0830

Other identifiers 3

IdentifierTypeStateIssuer
003444400MedicaidFL
8899886-00FLMedicaidFL
CD935AOtherFLMEDICARE PTAN

Other names 1

  • Kids Therapy Korner Doing business as

National Provider Directory

National Provider Directory

Locations

667 Kingsley Ave
#A
Orange Park, FL 32073
Phone (904) 375-0830

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1487891859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8563 ARGYLE BUSINESS LOOP",
            "address_2": "SUITE #2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446668",
            "telephone_number": "904-375-0830",
            "fax_number": "877-811-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8563 ARGYLE BUSINESS LOOP",
            "address_2": "SUITE #2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446668",
            "telephone_number": "904-375-0830",
            "fax_number": "877-811-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYMPHEDEMA CARE CENTER OF NORTH FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "MARIANELA",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "904-375-0830",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OTR/L, CSIT, CLT"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "OT11418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003444400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8899886-00FL",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CD935A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Therapy Korner",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.