Fresh Heads Orlando, LLC

Primary specialty

Other TechnicianTaxonomy code 247200000X

Legal business name

FRESH HEADS ORLANDO, LLC

Practice address

2273 Lee Rd Ste 100
Winter Park, FL 32789-7213

Phone

(904) 235-3157

NPI assigned

Jun 15, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Dwight Lee Ottesen

Title

Owner

Phone

(904) 686-4175

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1700316460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 LAKE STONE CIR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824342",
            "telephone_number": "904-235-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2273 LEE RD STE 100",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327897213",
            "telephone_number": "904-235-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH HEADS ORLANDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "OTTESEN",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-686-4175",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jeremy Gordon Freye, LMFT, M.DIV.
• Catherine Belle Friant
• Britni Frias
• Raphaela Frias
• Darcie Friedberg, MA, LMHC, NCC

• Other Technician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Other Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; 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.