=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891068912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL4KIDSLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2012
-----------------------------------------------------
Last Update Date | 02/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7110 YARDLEY WAY
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33647-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-486-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7110 YARDLEY WAY
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33647-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-486-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. CINDY HADDAD COOLEY
-----------------------------------------------------
Credential | MSOTR/L
-----------------------------------------------------
Telephone | 813-486-7728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT11018
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------