Provider Demographics
NPI:1174280325
Name:ACHIEVE PEDIATRIC THERAPY, INC
Entity Type:Organization
Organization Name:ACHIEVE PEDIATRIC THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:407-277-5400
Mailing Address - Street 1:11602 LAKE UNDERHILL ROAD,
Mailing Address - Street 2:SUITE 129
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825
Mailing Address - Country:US
Mailing Address - Phone:407-277-5400
Mailing Address - Fax:321-281-4942
Practice Address - Street 1:11602 LAKE UNDERHILL ROAD,
Practice Address - Street 2:SUITE 129
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:321-281-4942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACHIEVE PEDIATRIC THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024402800Medicaid