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General NPI Number Information
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NPI Number | 1093590648
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Entity Type | Organization
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Legal Business Name | KID'S THERAPY LAND BILINGUAL SPEECH LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 12900 SAWGRASS PINE CIR
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City | ORLANDO
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State | FL
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Zip | 32824-4890
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Country | US
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Telephone | 407-777-0682
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Fax | 407-777-0682
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Provider Business Mailing Address
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Address Line | 12900 SAWGRASS PINE CIR
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City | ORLANDO
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State | FL
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Zip | 32824-4890
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Country | US
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Telephone | 407-777-0682
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Fax | 407-777-0682
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Authorized Official
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Title or Position | MANAGER
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Name | MARIA MONICA BRAVO BUCKINGHAM
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Credential |
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Telephone | 321-697-6609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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