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General NPI Number Information
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NPI Number | 1831536515
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Entity Type | Organization
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Legal Business Name | FLORIDA LIONS CONKLIN CTRS FOR THE BLIND
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 405 WHITE ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2925
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Country | US
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Telephone | 386-258-3441
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Fax | 386-258-1155
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Provider Business Mailing Address
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Address Line | 405 WHITE ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2925
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Country | US
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Telephone | 386-258-3441
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Fax | 386-258-1155
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT T KELLY
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Credential | CRC
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Telephone | 386-258-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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