MEDICARE: CHILDREN'S THERAPY CENTER & MORE, INC.

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	225X00000X	Occupational Therapist	OT6348	FL
2	2355S0801X	Speech-Language Assistant	SI2159	FL
3	2355S0801X	Speech-Language Assistant	SI2315	FL
4	2355S0801X	Speech-Language Assistant	SI1600	FL
5	235Z00000X	Speech-Language Pathologist	SA9928	FL
6	235Z00000X	Speech-Language Pathologist	SA11679	FL
7	235Z00000X	Speech-Language Pathologist	SA10914	FL
8	235Z00000X	Speech-Language Pathologist	SZ6478	FL
9	235Z00000X	Speech-Language Pathologist	SA5276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1669514246	OTHER	FL	INDIVIDUAL NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285878355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S THERAPY CENTER & MORE, INC.

Provider Business Mailing Address
First Line	:	4474 WESTON RD
Second Line	:	MB 214
City	:	DAVIE
State	:	FL
Zip	:	33331-3195
Country	:	US
Telephone Number	:	954-644-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 EXECUTIVE PARK DRIVE
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3195
Country	:	US
Telephone Number	:	954-644-2645
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. EDITH LISBETH JACIR
Credential	:	M.A., CCC-SLP
Telephone Number	:	954-644-2645

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	09/18/2024

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