Healthcare Provider Details

I. General information

NPI: 1538384698
Provider Name (Legal Business Name): OUR CHILDREN'S ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BURNS AVE
LAKE WALES FL
33853-3335
US

IV. Provider business mailing address

555 BURNS AVE
LAKE WALES FL
33853-3335
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-3338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHARON MCMANUS
Title or Position: PRINCIPAL
Credential:
Phone: 863-294-1429