Healthcare Provider Details

I. General information

NPI: 1174280325
Provider Name (Legal Business Name): ACHIEVE PEDIATRIC THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL ROAD, SUITE 129
ORLANDO FL
32825
US

IV. Provider business mailing address

11602 LAKE UNDERHILL ROAD, SUITE 129
ORLANDO FL
32825
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 407-277-5400
  • Fax: 321-281-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: HEATHER B GRAY
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: O.T.
Phone: 407-277-5400