MEDICARE: TINY PALMS SPEECH THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA12319	FL

General Provider Information

NPI Number	:	1215387956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY PALMS SPEECH THERAPY

Provider Business Mailing Address
First Line	:	5625 GOLDEN EAGLE CIR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1521
Country	:	US
Telephone Number	:	954-604-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 GOLDEN EAGLE CIR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1521
Country	:	US
Telephone Number	:	954-604-1085
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/SPEECH PATHOLOGIST
Name	:	CARLA RODRIGUEZ
Credential	:	MS. CCC-SLP
Telephone Number	:	954-604-1085

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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Directions to “TINY PALMS SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

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