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General NPI Number Information
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NPI Number | 1508243940
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Entity Type | Organization
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Legal Business Name | KIDS SPOT
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1 OAKWOOD BLVD 130
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1956
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Country | US
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Telephone | 954-925-3844
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Fax |
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Provider Business Mailing Address
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Address Line | OAKWOOD BLVD 130
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City | HOLLYWOOD
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State | FL
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Zip | 33020
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Country | US
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Telephone | 954-925-3844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNIE BOUCHEREAU-FISCHER
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Credential | PT
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Telephone | 954-925-3844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SI 2541
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License Number State | FL
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