Provider Demographics
NPI:1952790289
Name:SUCCESS FOR KIDS LLC
Entity Type:Organization
Organization Name:SUCCESS FOR KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:954-865-3705
Mailing Address - Street 1:1636 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-5508
Mailing Address - Country:US
Mailing Address - Phone:954-865-3705
Mailing Address - Fax:954-337-0141
Practice Address - Street 1:1636 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-5508
Practice Address - Country:US
Practice Address - Phone:954-865-3705
Practice Address - Fax:954-337-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11518225X00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891985200Medicaid
FL010042600Medicaid