MEDICARE: BABY BLISS FEEDING COLLABORATIVE OF CENTRAL FLORIDA, LLC

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	225X00000X	Occupational Therapist
2	163WL0100X	Lactation Consultant (Registered Nurse)

General Provider Information

NPI Number	:	1518603984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABY BLISS FEEDING COLLABORATIVE OF CENTRAL FLORIDA, LLC

Provider Business Mailing Address
First Line	:	10967 LAKE UNDERHILL RD STE 138
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-4455
Country	:	US
Telephone Number	:	407-391-1163
Fax Number	:

Provider Business Practice Location Address
First Line	:	10967 LAKE UNDERHILL RD STE 138
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-4455
Country	:	US
Telephone Number	:	407-391-1163
Fax Number	:	321-348-5786

Authorized Official
Title or Position	:	CO-MANAGER/CO-FOUNDER
Name	:	SABRINA BARBER
Credential	:	BSN, RN, IBCLC
Telephone Number	:	407-748-6439

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/09/2022

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