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General NPI Number Information
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NPI Number | 1952790289
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Entity Type | Organization
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Legal Business Name | SUCCESS FOR KIDS LLC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 1636 NW 5TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-5508
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Country | US
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Telephone | 954-865-3705
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Fax | 954-337-0141
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Provider Business Mailing Address
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Address Line | 1636 NW 5TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-5508
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Country | US
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Telephone | 954-865-3705
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Fax | 954-337-0141
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/ OWNER
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Name | MS. ANITA M DAVID
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Credential | OTR
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Telephone | 954-865-3705
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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 | OT11518
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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 | OT11518
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License Number State | FL
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