MEDICARE: MRS. MARTA M GARCIA ITDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235812975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTA M GARCIA ITDS

Provider Business Mailing Address
First Line	:	PO BOX 162191
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-2191
Country	:	US
Telephone Number	:	407-437-2318
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 ELLSWORTH ST
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6803
Country	:	US
Telephone Number	:	407-437-2318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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