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General NPI Number Information
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NPI Number | 1780137455
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Entity Type | Organization
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Legal Business Name | AXIOM
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 2400 RIVER TREE CIR
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City | SANFORD
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State | FL
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Zip | 32771-8332
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Country | US
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Telephone | 407-252-1021
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 RIVER TREE CIR
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City | SANFORD
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State | FL
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Zip | 32771-8332
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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 | OTR/L
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Name | DENISE FULMORE
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Credential |
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Telephone | 407-252-1021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | OT1201
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License Number State | FL
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