Healthcare Provider Details

I. General information

NPI: 1013635358
Provider Name (Legal Business Name): MY THERAPY SPOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18822 NW 80TH CT
HIALEAH FL
33015-5228
US

IV. Provider business mailing address

18822 NW 80TH CT
HIALEAH FL
33015-5228
US

V. Phone/Fax

Practice location:
  • Phone: 305-440-0785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TRAVIESO
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: SLP
Phone: 305-440-0785