Healthcare Provider Details

I. General information

NPI: 1760245823
Provider Name (Legal Business Name): CANTELOPE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 DELLA DR
ORLANDO FL
32819-5139
US

IV. Provider business mailing address

7202 DELLA DR
ORLANDO FL
32819-5139
US

V. Phone/Fax

Practice location:
  • Phone: 321-368-1087
  • Fax:
Mailing address:
  • Phone: 321-368-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ANDJELA AVRAM
Title or Position: OWNER
Credential:
Phone: 321-368-1087