Healthcare Provider Details

I. General information

NPI: 1639547516
Provider Name (Legal Business Name): LIVE, LAUGH, ENABLE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13231 SW 87TH TER
MIAMI FL
33183-4166
US

IV. Provider business mailing address

13231 SW 87TH TER
MIAMI FL
33183-4166
US

V. Phone/Fax

Practice location:
  • Phone: 786-417-6531
  • Fax:
Mailing address:
  • Phone: 786-417-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. SUZANNE BARBARA ESCOBAR
Title or Position: DIRECTOR
Credential: COTA/L
Phone: 786-417-6531