Provider Demographics
NPI:1902143480
Name:ACHIEVE PEDIATRIC THERAPY EARLY INTERVENTION
Entity type:Organization
Organization Name:ACHIEVE PEDIATRIC THERAPY EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:407-277-5400
Mailing Address - Street 1:1525 S. ALAFAYA TRAIL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-277-5400
Mailing Address - Fax:321-281-4942
Practice Address - Street 1:1525 S ALAFAYA TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8926
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:321-281-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003591700Medicaid