Healthcare Provider Details

I. General information

NPI: 1831609254
Provider Name (Legal Business Name): MOUNTAINEER'S THERAPEUTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 KENWOOD RD
WEST PALM BEACH FL
33401-7408
US

IV. Provider business mailing address

1340 KENWOOD RD
WEST PALM BEACH FL
33401-7408
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-3938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE HUNNINGS
Title or Position: BCBA
Credential:
Phone: 910-366-5772