Progressive Behavior Management Res, Inc. | |
628 E Bloomingdale Ave Brandon FL 33511-8111 | |
(813) 525-5468 | |
(813) 438-8903 |
Full Name | Progressive Behavior Management Res, Inc. |
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Speciality | Occupational Therapist |
Location | 628 E Bloomingdale Ave, Brandon, Florida |
Authorized Official Name and Position | Stacey Denise Sparkman (OWNER/BCBA) |
Authorized Official Contact | 8135255468 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Progressive Behavior Management Res, Inc. 220 W Brandon Blvd Suite 210 Brandon FL 33511-5104 Ph: (813) 525-5468 | Progressive Behavior Management Res, Inc. 628 E Bloomingdale Ave Brandon FL 33511-8111 Ph: (813) 525-5468 |
NPI Number | 1336418417 |
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Provider Enumeration Date | 12/20/2011 |
Last Update Date | 05/01/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336418417 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103K00000X | Behavior Analyst | 1-07-3280 (Florida) | Secondary |
225X00000X | Occupational Therapist | OT 11898 (Florida) | Primary |
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