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General NPI Number Information
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NPI Number | 1437359619
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Entity Type | Organization
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Legal Business Name | ISLAND DOLPHIN CARE
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 150 LORELANE PL
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City | KEY LARGO
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State | FL
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Zip | 33037-4235
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Country | US
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Telephone | 305-451-5884
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Fax | 305-453-5399
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Provider Business Mailing Address
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Address Line | 150 LORELANE PL
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City | KEY LARGO
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State | FL
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Zip | 33037-4235
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Country | US
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Telephone | 305-451-5884
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Fax | 305-453-5399
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Authorized Official
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Title or Position | DIRECTOR OF THERAPY
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Name | DR. JACKIE R. MCINTOSH
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Credential | DPT
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Telephone | 305-451-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | PT18593
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License Number State | FL
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