Healthcare Provider Details

I. General information

NPI: 1902143480
Provider Name (Legal Business Name): ACHIEVE PEDIATRIC THERAPY EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S ALAFAYA TRL SUITE 102
ORLANDO FL
32828-8926
US

IV. Provider business mailing address

1525 S. ALAFAYA TRAIL SUITE 102
ORLANDO FL
32828
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 TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER B GRAY
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: M.S., OTR/L
Phone: 407-277-5400