MEDICARE: DYNAMIC CHILDREN'S THERAPY 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	225XP0200X	Pediatric Occupational Therapist	OT11243	FL

General Provider Information

NPI Number	:	1376776880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC CHILDREN'S THERAPY INC

Provider Business Mailing Address
First Line	:	10350 SW 137TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6810
Country	:	US
Telephone Number	:	305-431-7136
Fax Number	:	305-408-8530

Provider Business Practice Location Address
First Line	:	10350 SW 137TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6810
Country	:	US
Telephone Number	:	305-431-7136
Fax Number	:	305-408-8530

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. MONICA RAQUEL PHILLIPS
Credential	:	OTR/L
Telephone Number	:	305-431-7136

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	08/31/2009

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