Provider Demographics
NPI:1053063552
Name:SNICKERS&GIGGLES
Entity Type:Organization
Organization Name:SNICKERS&GIGGLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CTRI, LMT
Authorized Official - Phone:352-278-0768
Mailing Address - Street 1:734 SW 179TH AVE
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667-3752
Mailing Address - Country:US
Mailing Address - Phone:352-278-0768
Mailing Address - Fax:
Practice Address - Street 1:18114 SE COUNTY ROAD 234
Practice Address - Street 2:
Practice Address - City:MICANOPY
Practice Address - State:FL
Practice Address - Zip Code:32667-5349
Practice Address - Country:US
Practice Address - Phone:352-278-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty