Healthcare Provider Details

I. General information

NPI: 1578997268
Provider Name (Legal Business Name): LITTLE TESLA PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 KINGSPOINTE PKWY STE 14
ORLANDO FL
32819-6542
US

IV. Provider business mailing address

6230 MORNING MIST LN
ORLANDO FL
32819-6915
US

V. Phone/Fax

Practice location:
  • Phone: 321-732-3723
  • Fax: 321-352-7168
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 12747
License Number StateFL

VIII. Authorized Official

Name: VESNA CANDIC
Title or Position: DIRECTOR
Credential: OTR
Phone: 321-368-2172