Healthcare Provider Details

I. General information

NPI: 1326206541
Provider Name (Legal Business Name): FUNTASTIC DISCOVERIES SENSORY GYM & SPEECH LANGUAGE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 SHERIDAN ST SUITE 201B
HOLLYWOOD FL
33021-1407
US

IV. Provider business mailing address

4330 SHERIDAN ST SUITE 201B
HOLLYWOOD FL
33021-1407
US

V. Phone/Fax

Practice location:
  • Phone: 954-802-1680
  • Fax:
Mailing address:
  • Phone: 954-802-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSA1331
License Number StateFL

VIII. Authorized Official

Name: MRS. LARA BATKILIN
Title or Position: PRESIDENT
Credential:
Phone: 954-802-1680