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General NPI Number Information
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NPI Number | 1447075759
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Entity Type | Organization
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Legal Business Name | EARLY INTERVENTION THERAPY SERVICES, LLC.
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 3531 CUNNINGHAM RD
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City | ORANGE PARK
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State | FL
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Zip | 32065-8228
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Country | US
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Telephone | 912-663-1815
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 CUNNINGHAM RD
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City | ORANGE PARK
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State | FL
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Zip | 32065-8228
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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, ITDS
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Name | KANDISE NICOLE SANDERS
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Credential |
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Telephone | 912-663-1815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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