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General NPI Number Information
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NPI Number | 1245633544
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Entity Type | Organization
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Legal Business Name | TAMPA BAY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 1807 PEPPERTREE DR
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City | OLDSMAR
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State | FL
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Zip | 34677-2741
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Country | US
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Telephone | 304-374-1252
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Fax |
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Provider Business Mailing Address
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Address Line | 16025 MUIRFIELD DR
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City | ODESSA
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State | FL
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Zip | 33556-2861
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MBR
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Name | STEPHANIE KOLANKO
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Credential | OTR/L
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Telephone | 304-374-1252
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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 | OT14203
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License Number State | FL
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