Healthcare Provider Details

I. General information

NPI: 1780194738
Provider Name (Legal Business Name): DAZZLING KIDS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 SW 8TH ST
MIAMI FL
33144
US

IV. Provider business mailing address

8470 SW 8TH ST
MIAMI FL
33144
US

V. Phone/Fax

Practice location:
  • Phone: 305-603-8105
  • Fax: 305-703-4951
Mailing address:
  • Phone: 305-603-8105
  • Fax: 305-703-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MAYLOREN MENDEZ
Title or Position: OWNER
Credential:
Phone: 305-603-8105