Healthcare Provider Details

I. General information

NPI: 1871262147
Provider Name (Legal Business Name): FIRST STEP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N CENTRAL AVE STE 110
KISSIMMEE FL
34741-4439
US

IV. Provider business mailing address

1200 N CENTRAL AVE STE 110
KISSIMMEE FL
34741-4439
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax: 877-399-5570
Mailing address:
  • Phone: 407-530-5063
  • Fax: 877-399-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS JEHAN FERESTE BANZON MUNOZ
Title or Position: SPEECH THERAPIST
Credential: SLPA
Phone: 407-267-4060