Organization
CHILDHOOD COACH,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARCELLE HORN-MANDIOLA OTR (OWNER)
(407) 364-9070
Entity
Organization
Contact information
Practice address
309 FOX SQUIRREL LN, LONGWOOD, FL 32779-4904
(407) 364-9070
Mailing address
309 FOX SQUIRREL LN, LONGWOOD, FL 32779-4904
(407) 364-9070
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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