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General NPI Number Information
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NPI Number | 1699363291
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Entity Type | Organization
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Legal Business Name | JUMPSTART DEVELOPMENTAL SERVICES LLC
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 5979 NW 151ST ST STE 102I
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2434
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Country | US
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Telephone | 786-431-5801
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Fax | 786-353-9177
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Provider Business Mailing Address
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Address Line | 5979 NW 151ST ST STE 102I
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2434
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Country | US
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Telephone | 786-431-5801
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Fax | 786-353-9177
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | RYAN JUSTIN MONTOTO
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Credential |
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Telephone | 786-245-1405
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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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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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 | 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 #4
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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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