Healthcare Provider Details

I. General information

NPI: 1891244505
Provider Name (Legal Business Name): BUBBLES THERAPY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11724 CRANBOURNE DR
ORLANDO FL
32837-5756
US

IV. Provider business mailing address

11724 CRANBOURNE DR
ORLANDO FL
32837-5756
US

V. Phone/Fax

Practice location:
  • Phone: 407-729-8498
  • Fax:
Mailing address:
  • Phone: 407-729-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14184
License Number StateFL

VIII. Authorized Official

Name: MS. MIRIAM MEDINA
Title or Position: PRESIDENT
Credential: M.S/SLP
Phone: 407-729-8498