MEDICARE: CHILDREN'S THERAPY ZONE, 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1508373085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S THERAPY ZONE, INC

Provider Business Mailing Address
First Line	:	11523 NW 6TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-4117
Country	:	US
Telephone Number	:	954-753-7650
Fax Number	:	954-753-7650

Provider Business Practice Location Address
First Line	:	11523 NW 6TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-4117
Country	:	US
Telephone Number	:	954-753-7650
Fax Number	:	954-753-7650

Authorized Official
Title or Position	:	SPEECH AND LANGUAGE PATHOLOGIST
Name	:	MRS. MAYOMY ANNETTE VILLAFANE
Credential	:	MS
Telephone Number	:	954-753-7650

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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Directions to “CHILDREN'S THERAPY ZONE, INC ” Practice Location

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