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General NPI Number Information
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NPI Number | 1205001492
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Entity Type | Organization
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Legal Business Name | KIDS MPOWERED
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 649 E ALEXANDER ST
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City | PLANT CITY
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State | FL
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Zip | 33563-7126
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Country | US
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Telephone | 813-767-8740
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Fax | 813-473-4621
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Provider Business Mailing Address
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Address Line | 649 E ALEXANDER ST
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City | PLANT CITY
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State | FL
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Zip | 33563-7126
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Country | US
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Telephone | 813-767-8740
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Fax | 813-473-4621
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. GENEVA E. AUSTIN
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Credential | M.S., CCC/SLP
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Telephone | 813-767-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT3546
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA7832
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License Number State | FL
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