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Organization
FLORIDA NEUROCOGNITIVE DEVELOPMENT CENTER
Active
Organization
FLORIDA NEUROCOGNITIVE DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE ABBY KOCH PH.D. (PRESIDENT)
(813) 399-1625
Entity
Organization
Contact information
Practice address
3815 MARYWEATHER LN, SUITE 101, WESLEY CHAPEL, FL 33544-7792
(813) 399-1625
(813) 873-8837
Mailing address
3815 MARYWEATHER LN, SUITE 101, WESLEY CHAPEL, FL 33544-7792
(813) 399-1625
(813) 873-8837
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PY4230
FL
235Z00000X
Speech-Language Pathologist
SA3850
FL
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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