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General NPI Number Information
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NPI Number | 1720337348
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Entity Type | Organization
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Legal Business Name | OUR CHILDREN'S MIDDLE ACADEMY
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 150 AVENUE B, SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-294-1429
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Fax |
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Provider Business Mailing Address
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Address Line | 150 AVENUE B, SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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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 | BILLING REPRESENTATIVE
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Name | KELLY REMOR
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Credential |
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Telephone | 863-294-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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