Healthcare Provider Details

I. General information

NPI: 1205347101
Provider Name (Legal Business Name): EARLY INTERVENTION SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 LAND O LAKES BLVD
LAND O LAKES FL
34639-4413
US

IV. Provider business mailing address

22214 SHORESIDE DR
LAND O LAKES FL
34639-4615
US

V. Phone/Fax

Practice location:
  • Phone: 813-335-1173
  • Fax: 813-996-9691
Mailing address:
  • Phone: 813-335-1173
  • Fax: 813-996-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY WHITAKER
Title or Position: FOUNDER
Credential:
Phone: 813-335-1173