Provider Demographics
NPI:1700193679
Name:CHILDREN'S THERAPY CENTER & MORE, INC.
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER & MORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:LISBETH
Authorized Official - Last Name:JACIR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:954-385-8560
Mailing Address - Street 1:4474 WESTON RD
Mailing Address - Street 2:MB 214
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3195
Mailing Address - Country:US
Mailing Address - Phone:954-385-8560
Mailing Address - Fax:954-385-9505
Practice Address - Street 1:2751 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3660
Practice Address - Country:US
Practice Address - Phone:954-385-8560
Practice Address - Fax:954-385-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6348225X00000X
FLSI21592355S0801X
FLSI23152355S0801X
FLSI16002355S0801X
FLSA9928235Z00000X
FLSA5276235Z00000X
FLSZ6478235Z00000X
FLSA11679235Z00000X
FLSA10914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001160101Medicaid