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Organization

CHILDHOOD INTERVENTIONS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KIMBERLEE SPENCER PH.D. (OWNER)
(817) 800-2117
Entity
Organization

Contact information

Practice address
1500 KINGS RD, CANTONMENT, FL 32533-8953
(817) 800-2117
Mailing address
1500 KINGS RD, CANTONMENT, FL 32533-8953
(817) 800-2117

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
225XP0200X
Pediatric Occupational Therapist
235Z00000X
Speech-Language Pathologist
252Y00000X
Early Intervention Provider Agency
Primary

Other

Enumeration date
08/29/2022
Last updated
12/30/2022
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