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NPI Code Detail

MEDICARE: PALOMA ACADEMY INC

MEDICARE: PALOMA ACADEMY 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
1225X00000XOccupational Therapist
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1336788611
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALOMA ACADEMY INC
Provider Business Mailing Address
First Line : 2740 N HARBOR CITY BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-6291
Country : US
Telephone Number : 404-405-5113
Fax Number :
Provider Business Practice Location Address
First Line : 2740 N HARBOR CITY BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-6291
Country : US
Telephone Number : 404-405-5113
Fax Number :
Authorized Official
Title or Position : CEO
Name : SHERRY MARVINNY
Credential : RBT
Telephone Number : 404-405-5113
Provider Enumeration Date : 01/03/2020
Last Update Date : 04/04/2023

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