Organization
C12 MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN S CHILDERS (OT)
(727) 251-7782
Entity
Organization
Contact information
Practice address
333 16TH AVE SE, LARGO, FL 33771-4407
(727) 251-7782
Mailing address
8498 108TH WAY, SEMINOLE, FL 33772-4318
(727) 251-7782
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT10920
STATE LICENSE
FL
Enumeration date
11/08/2018
Last updated
11/08/2018
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