Healthcare Provider Details

I. General information

NPI: 1609953066
Provider Name (Legal Business Name): PEDS TO GO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4448 EDGEWATER DR
ORLANDO FL
32804-1216
US

IV. Provider business mailing address

4448 EDGEWATER DR
ORLANDO FL
32804-1216
US

V. Phone/Fax

Practice location:
  • Phone: 407-513-3000
  • Fax:
Mailing address:
  • Phone: 407-513-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberHHA 209360961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberHHA 209360961
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberHHA 209360961
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberHHA 209360961
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberHHA 209360961
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberHHA 209360961
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberHHA 209360961
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License NumberHHA 209360961
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License NumberHHA 209360961
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberHHA 209360961
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA 209360961
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHHA 209360961
License Number StateFL
# 13
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHHA 209360961
License Number StateFL
# 14
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberHHA 209360961
License Number StateFL

VIII. Authorized Official

Name: MRS. MELISSA OHLMACHER
Title or Position: MANAGER OF FINANCIAL SERVICES
Credential:
Phone: 407-513-3108