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Organization
SPARK OF LIFE THERAPY LLC
Active
Organization
SPARK OF LIFE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRAIDYS D HIDALGO (SLPA)
(954) 477-1486
Entity
Organization
Contact information
Practice address
6781 SCOTT ST, HOLLYWOOD, FL 33024-3936
(954) 477-1486
Mailing address
6781 SCOTT ST, HOLLYWOOD, FL 33024-3936
(954) 477-1486
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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