Provider Demographics
NPI:1497154454
Name:ONE GIANT LEAP. LLC
Entity Type:Organization
Organization Name:ONE GIANT LEAP. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SLP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:321-287-3467
Mailing Address - Street 1:679 PLANTATION KEY CIR
Mailing Address - Street 2:APT 201
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4667
Mailing Address - Country:US
Mailing Address - Phone:321-287-3467
Mailing Address - Fax:
Practice Address - Street 1:679 PLANTATION KEY CIR
Practice Address - Street 2:APT 201
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4667
Practice Address - Country:US
Practice Address - Phone:321-287-3467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12702261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech