Provider Demographics
NPI:1871262147
Name:FIRST STEP THERAPY LLC
Entity Type:Organization
Organization Name:FIRST STEP THERAPY LLC
Other - Org Name:FIRST STEP THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEHAN FERESTE
Authorized Official - Middle Name:BANZON
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLPA
Authorized Official - Phone:407-267-4060
Mailing Address - Street 1:1200 N CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4439
Mailing Address - Country:US
Mailing Address - Phone:407-530-5063
Mailing Address - Fax:877-399-5570
Practice Address - Street 1:1200 N CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4439
Practice Address - Country:US
Practice Address - Phone:407-530-5063
Practice Address - Fax:877-399-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767101925Medicaid