Provider Demographics
NPI:1093929770
Name:UNIVERSITY OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH FLORIDA
Other - Org Name:USF CHILD DEVELOPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-974-0601
Mailing Address - Street 1:13101 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3803
Mailing Address - Country:US
Mailing Address - Phone:813-974-0601
Mailing Address - Fax:813-558-1340
Practice Address - Street 1:13101 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3803
Practice Address - Country:US
Practice Address - Phone:813-974-0601
Practice Address - Fax:813-558-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty