Provider Demographics
NPI:1043466659
Name:CHILDREN FIRST THERAPEUTICS LLC
Entity Type:Organization
Organization Name:CHILDREN FIRST THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPTAIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:386-793-0612
Mailing Address - Street 1:65 FLEMINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9260
Mailing Address - Country:US
Mailing Address - Phone:386-793-0612
Mailing Address - Fax:386-447-5281
Practice Address - Street 1:65 FLEMINGWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9260
Practice Address - Country:US
Practice Address - Phone:386-793-0612
Practice Address - Fax:386-447-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT#10221251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889829401Medicaid