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General NPI Number Information
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NPI Number | 1114410149
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Entity Type | Organization
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Legal Business Name | KISMETS & REBELS, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 9609 SIMEON DR
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City | LAND O LAKES
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State | FL
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Zip | 34638-6923
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Country | US
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Telephone | 813-460-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 9609 SIMEON DR
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City | LAND O LAKES
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State | FL
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Zip | 34638-6923
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Country | US
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Telephone | 813-460-7767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KESHELL ALVIES
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Credential |
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Telephone | 813-460-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State | FL
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