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General NPI Number Information
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NPI Number | 1740513795
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Entity Type | Organization
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Legal Business Name | PEDIATRIC INTERVENTIONS INC.
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 2963 WERWOOD CT
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City | WELLINGTON
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State | FL
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Zip | 33414-7680
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Country | US
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Telephone | 561-635-7798
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Fax |
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Provider Business Mailing Address
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Address Line | 2963 WERWOOD CT
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City | WELLINGTON
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State | FL
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Zip | 33414-7680
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Country | US
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Telephone | 561-635-7798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISSETTE MARTINEZ
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Credential |
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Telephone | 561-635-7798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SI1114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT1522
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License Number State | FL
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