Healthcare Provider Details

I. General information

NPI: 1730253162
Provider Name (Legal Business Name): CHRIS THARRINGTON WATERS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 BAREFOOT CV
HYPOLUXO FL
33462-6508
US

IV. Provider business mailing address

132 BAREFOOT CV SUITE 1
HYPOLUXO FL
33462-6508
US

V. Phone/Fax

Practice location:
  • Phone: 850-339-3975
  • Fax:
Mailing address:
  • Phone: 850-339-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 1658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: