MEDICARE: CHILD AND FAMILY LEARING

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	103T00000X	Psychologist	PY0004230	FL

General Provider Information

NPI Number	:	1245634294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD AND FAMILY LEARING

Provider Business Mailing Address
First Line	:	10549 N FLORIDA AVE STE G
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6707
Country	:	US
Telephone Number	:	813-399-1625
Fax Number	:

Provider Business Practice Location Address
First Line	:	16105 CADBURY CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1135
Country	:	US
Telephone Number	:	813-399-1625
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. DIANE ABBY KOCH
Credential	:	PH.D.
Telephone Number	:	813-399-1625

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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Directions to “CHILD AND FAMILY LEARING ” Practice Location

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