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General NPI Number Information
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NPI Number | 1689545071
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Entity Type | Organization
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Legal Business Name | EMERALD COAST KIDS THERAPY GROUP LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 4944 MULDOON POINTE RD
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City | PENSACOLA
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State | FL
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Zip | 32526-1924
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Country | US
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Telephone | 848-350-5973
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3523
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City | PENSACOLA
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State | FL
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Zip | 32516-3523
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Country | US
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Telephone | 617-302-7272
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LISA RADER
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Credential | BCBA
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Telephone | 848-350-5973
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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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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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