FUNCTIONAL THERAPY LLC — NPI 1417235490 (Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) in PICAYUNE, MS)

CMS-1500 Box 24J / 33a • NPI

1417235490

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225X00000X (CMS 67)

Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)

Box 32 Service Location & ZIP+4

311 N MAIN ST, PICAYUNE, MS, 39466-3313

✓ 9-Digit EDI 837 ZIP+4 (39466-3313)

Practice Phone & Referral Fax

(601) 799-4065

Fax: (601) 620-4117

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417235490 (FUNCTIONAL THERAPY LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417235490` (NPI-2 Organization / Facility)
Provider / Legal Name	FUNCTIONAL THERAPY LLC
Plain-English Specialty	Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) NUCC Code: `225X00000X` (Occupational Therapist)
Certifying / Licensing Body	National Board for Certification in Occupational Therapy (NBCOT)
Practice Location Address	311 N MAIN ST, PICAYUNE, MS, 39466-3313
Practice Telephone / Fax	Tel: (601) 799-4065 \| Fax: (601) 620-4117
Administrative Mailing Address	7533 CROOKED STICK DR, DIAMONDHEAD, MS, 39525-3895
Enumeration & Last Sync	Enumerated: 2011-07-25 \| CMS Record Updated: 2014-12-31
Authorized Official	STACEY VOLLENWEIDER (owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

311 N MAIN ST, PICAYUNE, MS, 39466-3313

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Plain-English Taxonomy & CMS Crosswalk (225X00000X)

What Does Taxonomy Code 225X00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225X00000X translates to:
"Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 67 (Occupational Therapist in Private Practice)
Certifying / Accrediting Authority: National Board for Certification in Occupational Therapy (NBCOT)
Clinical Scope: Regaining hand function, fine motor skills, and independent daily living after stroke, hand injury, or pediatric developmental delay.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FUNCTIONAL THERAPY LLC)

Typical CPT / Diagnostic Procedures:

Activities of Daily Living (ADL) & Neuromuscular Re-Education (CPT 97530–97535)
Upper Extremity Hand Therapy, Custom Splinting & Home Safety Ergonomics

Common Therapeutic Classes:

Non-Pharmacological Functional & Sensory-Motor Rehabilitation Protocols

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225X00000X` — Occupational Therapist Plain English: Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)	State: MS \| License: `OT1249` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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FUNCTIONAL THERAPY LLC (NPI #1417235490)