OrganizationActive
Support Independent Living
NPI 1306590260 · Developmental Disabilities Clinic/Center · Fort Walton Beach, FL
Provider details
- NPI number
- 1306590260
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Brenda Marrier, Owner(850) 259-7190
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(61/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
11 Racetrack Rd Ne Ste C2
Fort Walton Beach, FL 32547-1867
Phone: (850) 259-7190
Street-level locationGet directions
Mailing address
11 Racetrack Rd Ne Ste C2
Fort Walton Beach, FL 32547-1867
Other names (DBA / former)
- Doing business as
- Support Independent Living
Registry dates
- Enumerated
- 2022-02-09
- Last updated
- 2022-02-09
- Certified
- 2022-02-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.