=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376189423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREAM BIGGER CHILDREN'S FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2019
-----------------------------------------------------
Last Update Date | 11/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9840 ALTERNATE A1A STE 402
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-291-8437
-----------------------------------------------------
Fax | 561-584-6785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9840 ALTERNATE A1A STE 402
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-291-8437
-----------------------------------------------------
Fax | 561-584-6785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. RANDALL A MAALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-291-8437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------