| NPI | 1013295450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE ABBY KOCH President 813-399-1625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY4230) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA3850) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-08-03 |