Healthcare Provider Details

I. General information

NPI: 1487454252
Provider Name (Legal Business Name): WONDER MIND KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

IV. Provider business mailing address

1661 RIVERSIDE AVE APT 320
JACKSONVILLE FL
32204-4025
US

V. Phone/Fax

Practice location:
  • Phone: 904-566-7888
  • Fax:
Mailing address:
  • Phone: 904-566-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE HALASZ
Title or Position: PEDIATRIC OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 904-566-7888