Provider Demographics
NPI:1427118512
Name:CHILDRENS THERAPY SPECIALISTS
Entity type:Organization
Organization Name:CHILDRENS THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR
Authorized Official - Phone:954-709-3513
Mailing Address - Street 1:8901 ORANGE GROVE DR
Mailing Address - Street 2:#C
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6957
Mailing Address - Country:US
Mailing Address - Phone:954-709-3513
Mailing Address - Fax:954-474-0701
Practice Address - Street 1:8901 ORANGE GROVE DR
Practice Address - Street 2:#C
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-6957
Practice Address - Country:US
Practice Address - Phone:954-709-3513
Practice Address - Fax:954-474-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10477225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887557000Medicaid
FL887557096Medicaid