Healthcare Provider Details

I. General information

NPI: 1962894303
Provider Name (Legal Business Name): CELESTIAL MIDWIFERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 OLYMPIA PARK CIR
OCOEE FL
34761-2427
US

IV. Provider business mailing address

1308 OLYMPIA PARK CIR
OCOEE FL
34761-2427
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-6874
  • Fax: 407-614-3658
Mailing address:
  • Phone: 407-923-6874
  • Fax: 407-614-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW279
License Number StateFL

VIII. Authorized Official

Name: MRS. CATHY CELESTE MCLEOD
Title or Position: LICENSED MIDWIFE/PRESIDENT
Credential: L.M.
Phone: 407-923-6874