Basic Information
| Provider Information | |||||||||
| NPI: | 1629619564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KID'S SPOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OAKWOOD BLVD STE 130 | ||||||||
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| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330201937 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1 OAKWOOD BLVD STE 130 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330201937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549253844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | ZUMMO | ||||||||
| AuthorizedOfficialFirstName: | ISABELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2164066493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CF-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.