Provider Demographics
NPI:1285352559
Name:OPTIMIZED WELLNESS LLC
Entity type:Organization
Organization Name:OPTIMIZED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:774-266-4672
Mailing Address - Street 1:290 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4041
Mailing Address - Country:US
Mailing Address - Phone:774-266-4672
Mailing Address - Fax:
Practice Address - Street 1:290 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4041
Practice Address - Country:US
Practice Address - Phone:774-266-4672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251E00000XAgenciesHome Health
No333600000XSuppliersPharmacy