Healthcare Provider Details

I. General information

NPI: 1720337348
Provider Name (Legal Business Name): OUR CHILDREN'S MIDDLE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVENUE B, SE
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

150 AVENUE B, SE
WINTER HAVEN FL
33880
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-1429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY REMOR
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 863-294-1429