Healthcare Provider Details

I. General information

NPI: 1619255015
Provider Name (Legal Business Name): PEDIATRIC POTENTIALS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST SUITE 209
CORAL SPRINGS FL
33065-4042
US

IV. Provider business mailing address

9750 NW 33RD ST SUITE 209
CORAL SPRINGS FL
33065-4042
US

V. Phone/Fax

Practice location:
  • Phone: 305-321-4343
  • Fax: 954-827-0308
Mailing address:
  • Phone: 305-321-4343
  • Fax: 954-827-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 10752
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA WEBSTER
Title or Position: SLP/OWNER
Credential: MACCC-SLP
Phone: 305-321-4343