Provider Demographics
NPI:1619854411
Name:MARIPOSA WELLNESS LLC
Entity type:Organization
Organization Name:MARIPOSA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:813-503-0169
Mailing Address - Street 1:16712 MAGNOLIA RESERVE PL
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4074
Mailing Address - Country:US
Mailing Address - Phone:910-420-3397
Mailing Address - Fax:
Practice Address - Street 1:16712 MAGNOLIA RESERVE PL
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4074
Practice Address - Country:US
Practice Address - Phone:813-503-0169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy