MEDICARE: CATHERINE RILEY M.A.,CCC-SLP

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	SA 8398	FL

General Provider Information

NPI Number	:	1225180060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE RILEY M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	724 SAINT THOMAS CV
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-3818
Country	:	US
Telephone Number	:	850-855-2489
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 EGLIN PKWY NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-4917
Country	:	US
Telephone Number	:	850-863-9973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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