Provider Demographics
NPI:1326206541
Name:FUNTASTIC DISCOVERIES SENSORY GYM & SPEECH LANGUAGE CENTER INC.
Entity Type:Organization
Organization Name:FUNTASTIC DISCOVERIES SENSORY GYM & SPEECH LANGUAGE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATKILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-802-1680
Mailing Address - Street 1:4330 SHERIDAN ST
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1407
Mailing Address - Country:US
Mailing Address - Phone:954-802-1680
Mailing Address - Fax:
Practice Address - Street 1:4330 SHERIDAN ST
Practice Address - Street 2:SUITE 201B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1407
Practice Address - Country:US
Practice Address - Phone:954-802-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13312355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty