Healthcare Provider Details

I. General information

NPI: 1376776880
Provider Name (Legal Business Name): DYNAMIC CHILDREN'S THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 SW 137TH CT
MIAMI FL
33186-6810
US

IV. Provider business mailing address

10350 SW 137TH CT
MIAMI FL
33186-6810
US

V. Phone/Fax

Practice location:
  • Phone: 305-431-7136
  • Fax: 305-408-8530
Mailing address:
  • Phone: 305-431-7136
  • Fax: 305-408-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11243
License Number StateFL

VIII. Authorized Official

Name: MRS. MONICA RAQUEL PHILLIPS
Title or Position: OWNER/DIRECTOR
Credential: OTR/L
Phone: 305-431-7136