MEDICARE: THE FOUNDRY FOUNDATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	106E00000X	Assistant Behavior Analyst
4	106S00000X	Behavior Technician
5	224Z00000X	Occupational Therapy Assistant
6	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1902431638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FOUNDRY FOUNDATION, INC

Provider Business Mailing Address
First Line	:	7360 OAKLAND HILLS DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2225
Country	:	US
Telephone Number	:	305-323-9892
Fax Number	:

Provider Business Practice Location Address
First Line	:	7360 OAKLAND HILLS DR
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2225
Country	:	US
Telephone Number	:	305-323-9892
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA GABRIELA FABRICIO
Credential	:
Telephone Number	:	305-323-9892

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/06/2020

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Directions to “THE FOUNDRY FOUNDATION, INC ” Practice Location

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