Healthcare Provider Details

I. General information

NPI: 1528496056
Provider Name (Legal Business Name): ANGELS CREATIVE CHILDRENS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 E COLONIAL DR
ORLANDO FL
32803-5219
US

IV. Provider business mailing address

4417 E COLONIAL DR
ORLANDO FL
32803-5219
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-0785
  • Fax: 407-757-0786
Mailing address:
  • Phone: 407-757-0785
  • Fax: 407-757-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARIA D NAVARRO
Title or Position: DIRECTOR
Credential:
Phone: 407-757-0785