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Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA PONCE COTA/L (PRESIDENT)
(786) 402-4157
Entity
Organization

Contact information

Practice address
6195 SW 160TH TER, DAVIE, FL 33331-3451
(786) 402-4157
Mailing address
6195 SW 160TH TER, DAVIE, FL 33331-3451

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
225XP0200X
Pediatric Occupational Therapist
Primary
2355S0801X
Speech-Language Assistant
235Z00000X
Speech-Language Pathologist

Other

Enumeration date
07/21/2022
Last updated
07/21/2022
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