Organization
EMPIRICAL PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAISEN STANGO (ADMINISTRATOR)
(407) 720-8006
Entity
Organization
Contact information
Practice address
3430 CULLEN LAKE SHORE DR, BELLE ISLE, FL 32812-1107
(407) 720-8006
Mailing address
3430 CULLEN LAKE SHORE DR, BELLE ISLE, FL 32812-1107
(407) 720-8006
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT12495
FL
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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