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NPI Code Detail

MEDICARE: CREATIVE LEARNING INC.

MEDICARE: CREATIVE LEARNING 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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811362999
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE LEARNING INC.
Provider Business Mailing Address
First Line : 453 KING ST
Second Line :
City : COCOA
State : FL
Zip : 32922-7621
Country : US
Telephone Number : 321-633-5511
Fax Number :
Provider Business Practice Location Address
First Line : 453 KING ST
Second Line :
City : COCOA
State : FL
Zip : 32922-7621
Country : US
Telephone Number : 321-633-5511
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DR. KATHRYN MENDOZA
Credential : BCBA,ED.D.
Telephone Number : 321-243-5284
Provider Enumeration Date : 12/01/2015
Last Update Date : 10/01/2020

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