Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 235Z00000X | Speech-Language Pathologist | | SA5826 | FLORIDA | No |
| 2 | 222Q00000X | Developmental Therapist | | | | No |
| 3 | 2251P0200X | Physical Therapist | Pediatrics | PT0002549 | FLORIDA | No |
| 4 | 225XP0200X | Occupational Therapist | Pediatrics | OT12452 | FLORIDA | No |
| 5 | 261Q00000X | Clinic/Center | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | ========= | OTHER | FLORIDA | GREAT WEST HEALTH INSURANCE |
| 2 | ========= | OTHER | FLORIDA | SOUTHCARE |
| 3 | 664175 | OTHER | FLORIDA | AETNA HEALTHCARE |
| 4 | 880357900 | MEDICAID | FLORIDA | |
| 5 | Y905L | OTHER | FLORIDA | BCBS OF FL GROUP ID |
| 6 | 024298400 | MEDICAID | FLORIDA | |
| 7 | 1407834021 | OTHER | FLORIDA | CIGNA BAYCARE |
| 8 | 880357904 | MEDICAID | FLORIDA | |
| 9 | ========= | OTHER | FLORIDA | HERITAGE CONSULTANTS |
| 10 | ========= | OTHER | FLORIDA | BEECHSTREET |
| 11 | 6406221 | OTHER | FLORIDA | UNITED HEALTHCARE |
| 12 | ========= | OTHER | FLORIDA | PRINCIPLE INSURANCE |
| 13 | 13424302 | OTHER | FLORIDA | CITRUS HEALTHCARE GRP ID |
| 14 | P10705914 | OTHER | FLORIDA | SIMPLY HEALTHCARE MEDICAID HMO |
| 15 | ========= | OTHER | FLORIDA | 1ST SERVICES ADM |
| 16 | 6406221 | OTHER | FLORIDA | UNITED HEALTHCARE MEDICAID HMO |
| 17 | 8810363001 | OTHER | FLORIDA | CIGNA HEALTHCARE |
| 18 | ========= | OTHER | FLORIDA | CHILDREN'S MEDICAL SERVICES |
| 19 | ========= | OTHER | FLORIDA | HUMANA |
| 20 | ========= | OTHER | FLORIDA | TRICARE |
| 21 | Y906F | OTHER | FLORIDA | BCBS FL GROUP ID |
