MEDICARE: DEBBIE GALE ITDS 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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1518392919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBBIE GALE ITDS INC.

Provider Business Mailing Address
First Line	:	2172 CAPE HEATHER CIR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3513
Country	:	US
Telephone Number	:	239-839-0816
Fax Number	:	239-673-9369

Provider Business Practice Location Address
First Line	:	2172 CAPE HEATHER CIR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3513
Country	:	US
Telephone Number	:	239-839-0816
Fax Number	:	239-673-9369

Authorized Official
Title or Position	:	OWNER
Name	:	DEBBIE GALE
Credential	:
Telephone Number	:	239-839-0816

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/05/2013

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