MEDICARE: EARLY STEPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	222Q00000X	FL

General Provider Information

NPI Number	:	1063617421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY STEPS

Provider Business Mailing Address
First Line	:	4827 PURITAN CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-8352
Country	:	US
Telephone Number	:	813-989-0435
Fax Number	:

Provider Business Practice Location Address
First Line	:	4827 PURITAN CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-8352
Country	:	US
Telephone Number	:	813-989-0435
Fax Number	:

Authorized Official
Title or Position	:	ITDS
Name	:	MRS. AMARILIS A MOYA
Credential	:
Telephone Number	:	813-989-0435

Provider Enumeration Date	:	06/17/2007
Last Update Date	:	06/16/2008

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Directions to “EARLY STEPS ” Practice Location

Language	Start Address	Practice Location

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