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General NPI Number Information
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NPI Number | 1316421456
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Entity Type | Organization
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Legal Business Name | SPECIAL KIDS INNOVATION PROGRAM INC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 150 AVENUE B SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3037
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Country | US
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Telephone | 863-294-1429
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Fax | 863-298-0299
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Provider Business Mailing Address
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Address Line | 150 AVENUE B SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3037
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Country | US
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Telephone | 863-294-1429
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Fax | 863-298-0299
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHARON COMKOWYCZ
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Credential | MS CCC-SLP
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Telephone | 863-294-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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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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