Provider Demographics
NPI:1700012523
Name:THERAKIDS
Entity Type:Organization
Organization Name:THERAKIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELON
Authorized Official - Middle Name:N
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-368-7728
Mailing Address - Street 1:1325 SE 25TH LOOP STE 102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6090
Mailing Address - Country:US
Mailing Address - Phone:352-368-7728
Mailing Address - Fax:352-368-3808
Practice Address - Street 1:1325 SE 25TH LOOP STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6090
Practice Address - Country:US
Practice Address - Phone:352-368-7728
Practice Address - Fax:352-368-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty