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General NPI Number Information
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NPI Number | 1497550602
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Entity Type | Organization
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Legal Business Name | THERA-CARE PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 11724 CRANBOURNE DR
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City | ORLANDO
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State | FL
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Zip | 32837-5756
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Country | US
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Telephone | 407-729-8498
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Fax |
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Provider Business Mailing Address
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Address Line | 11724 CRANBOURNE DR
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City | ORLANDO
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State | FL
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Zip | 32837-5756
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Country | US
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Telephone | 407-729-8498
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MIRIAM MEDINA
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Credential | MS/SLP
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Telephone | 407-729-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 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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