Basic Information
| Provider Information | |||||||||
| NPI: | 1467177493 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SKILLS TO GROW LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322059333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042524501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3750 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322059333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042524501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHILSON | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9042524501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTD, OTR/L | ||||||||
| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251E00000X | Y | Agencies | Home Health |
No ID Information.