MEDICARE: MAGIKIDZ, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	225XP0200X	Pediatric Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	2251P0200X	Pediatric Physical Therapist
4	252Y00000X	Early Intervention Provider Agency	FL

General Provider Information

NPI Number	:	1093207664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGIKIDZ, INC

Provider Business Mailing Address
First Line	:	6850 W 16TH DR APT 219
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4459
Country	:	US
Telephone Number	:	786-278-0623
Fax Number	:	305-602-8466

Provider Business Practice Location Address
First Line	:	6850 W 16TH DR APT 219
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014
Country	:	US
Telephone Number	:	786-278-0623
Fax Number	:	305-602-8466

Authorized Official
Title or Position	:	ITDS/PRESIDENT
Name	:	MRS. MERCEDES MARIA ACOSTA
Credential	:
Telephone Number	:	786-278-0623

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	08/15/2018

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Directions to “MAGIKIDZ, INC ” Practice Location

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