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
1	225100000X	Physical Therapist
2	2251P0200X	Pediatric Physical Therapist
3	225X00000X	Occupational Therapist
4	225XP0200X	Pediatric Occupational Therapist
5	2278P3900X	Neonatal/Pediatric Certified Respiratory Therapist
6	227900000X	Registered Respiratory Therapist
7	235Z00000X	Speech-Language Pathologist
8	261QM3000X	Medically Fragile Infants and Children Day Care

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	:	1609378116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S CARE CAMPUS, INC.

Provider Business Mailing Address
First Line	:	4448 EDGEWATER DR
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	:	7621 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6667
Country	:	US
Telephone Number	:	407-513-3000
Fax Number	:	407-515-6537

Authorized Official
Title or Position	:	CONTRACT ADMINISTRATOR
Name	:	MR. BRIAN C JUSTICE
Credential	:
Telephone Number	:	407-513-3000

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/01/2018

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

Language	Start Address	Practice Location

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