Healthcare Provider Details

I. General information

NPI: 1154418135
Provider Name (Legal Business Name): KIDS SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1937
US

IV. Provider business mailing address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1937
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3844
  • Fax: 954-925-3845
Mailing address:
  • Phone: 954-925-3844
  • Fax: 954-925-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10949
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNIE FISCHER
Title or Position: PRESIDENT
Credential: MPT
Phone: 954-445-3064