Healthcare Provider Details

I. General information

NPI: 1487182044
Provider Name (Legal Business Name): ILDMARIE COLON-AROCHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK PLACE BLVD
KISSIMMEE FL
34741-2345
US

IV. Provider business mailing address

375 PALM SPRINGS DR
ALTAMONTE SPRINGS FL
32701-3506
US

V. Phone/Fax

Practice location:
  • Phone: 407-433-5816
  • Fax:
Mailing address:
  • Phone: 407-683-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number976
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2943
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: