MEDICARE: CHILDREN'S CARE CAMPUS, INC.

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	2251P0200X	Pediatric Physical Therapist	60080980	FL
2	225X00000X	Occupational Therapist	60080980	FL
3	225XP0200X	Pediatric Occupational Therapist	60080980	FL
4	227800000X	Certified Respiratory Therapist	60080980	FL
5	2278P3900X	Neonatal/Pediatric Certified Respiratory Therapist	60080980	FL
6	235Z00000X	Speech-Language Pathologist	60080980	FL
7	261QM3000X	Medically Fragile Infants and Children Day Care	60080980	FL
8	225100000X	Physical Therapist	60080980	FL

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	:	1265510523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S CARE CAMPUS, INC.

Provider Business Mailing Address
First Line	:	4448 EDGE WATER DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-1216
Country	:	US
Telephone Number	:	407-513-3000
Fax Number	:	407-515-6537

Provider Business Practice Location Address
First Line	:	196 SOUTH SEMORAN BLVD.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3293
Country	:	US
Telephone Number	:	407-513-3000
Fax Number	:	407-515-6537

Authorized Official
Title or Position	:	FINANCIAL SERVICES MANAGER
Name	:	MS. MELISSIA OHLMACHER
Credential	:
Telephone Number	:	407-513-3000

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	04/14/2015

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Directions to “CHILDREN'S CARE CAMPUS, INC. ” Practice Location

Language	Start Address	Practice Location

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