MEDICARE: MRS. LINDA TATUM-RILEY M.S. 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 1245	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202579	OTHER	FL	AMERIGROUP PROVIDER NUMBE
2	18348	OTHER	FL	STAYWELL PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730226168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA TATUM-RILEY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 555907
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32855-5907
Country	:	US
Telephone Number	:	407-298-5300
Fax Number	:	407-296-0026

Provider Business Practice Location Address
First Line	:	6388 SILVER STAR RD
Second Line	:	SUITE 2E
City	:	ORLANDO
State	:	FL
Zip	:	32818-3235
Country	:	US
Telephone Number	:	407-298-5300
Fax Number	:	407-296-0026

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/09/2007

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Directions to “ MRS. LINDA TATUM-RILEY M.S. CCC-SLP” Practice Location

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