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NPI Code Detail

MEDICARE: ATLANTIC SPEECH THERAPY

MEDICARE: ATLANTIC 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
1171W00000XContractor15996FL

General Provider Information

NPI Number : 1881021749
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTIC SPEECH THERAPY
Provider Business Mailing Address
First Line : 11512 LAKE MEAD AVE UNIT 604
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-9686
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11512 LAKE MEAD AVE UNIT 604
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-9686
Country : US
Telephone Number : 904-652-5408
Fax Number :
Authorized Official
Title or Position : DIRECTOR/OWNER
Name : JESSICA OTTO
Credential :
Telephone Number : 904-652-5408
Provider Enumeration Date : 10/08/2013
Last Update Date : 10/08/2013

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Directions to “ATLANTIC SPEECH THERAPY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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