MEDICARE: MRS. MICHELLE THEMIDES TURNER 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	SA9767	FL
2	261QH0700X	Hearing and Speech Clinic/Center	SA9767	FL

General Provider Information

NPI Number	:	1639315773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE THEMIDES TURNER CCC-SLP

Provider Business Mailing Address
First Line	:	10616 GRETNA GREEN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1832
Country	:	US
Telephone Number	:	813-926-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6924 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5800
Country	:	US
Telephone Number	:	813-962-6766
Fax Number	:

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

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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