Organization
NOURISH PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA STEVENS MS, CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(407) 227-8370
Entity
Organization
Contact information
Practice address
1900 JAKE ST UNIT 105, ORLANDO, FL 32814-5915
(407) 227-8370
Mailing address
1900 JAKE ST UNIT 105, ORLANDO, FL 32814-5915
(407) 227-8370
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
FL
225X00000X
Occupational Therapist
—
FL
235Z00000X
Speech-Language Pathologist
—
FL
252Y00000X
Early Intervention Provider Agency
—
FL
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/04/2017
Last updated
12/01/2017
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