Provider Demographics
NPI:1346780483
Name:ASSISTIVE TECHNOLOGY EVALUATIONS AND SERVICES, LLC
Entity Type:Organization
Organization Name:ASSISTIVE TECHNOLOGY EVALUATIONS AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ATP
Authorized Official - Phone:352-536-4981
Mailing Address - Street 1:1357 SELBYDON WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4652
Mailing Address - Country:US
Mailing Address - Phone:352-536-4981
Mailing Address - Fax:
Practice Address - Street 1:1357 SELBYDON WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4652
Practice Address - Country:US
Practice Address - Phone:352-536-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018949100Medicaid
FL018669400Medicaid