MEDICARE: WONDERKIDS OCCUPATIONAL THERAPY, 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	225XP0200X	Pediatric Occupational 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	:	1710561667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDERKIDS OCCUPATIONAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	12601 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5009
Country	:	US
Telephone Number	:	352-559-9500
Fax Number	:	352-559-0585

Provider Business Practice Location Address
First Line	:	12601 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5009
Country	:	US
Telephone Number	:	352-559-9500
Fax Number	:	352-559-0585

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	MRS. DESIREE CAROLINA HARDWICK
Credential	:	OTR/L; NTMTC
Telephone Number	:	915-253-1691

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/12/2022

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