Healthcare Provider Details

I. General information

NPI: 1497111959
Provider Name (Legal Business Name): TALK ACTIVE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W BASS ST
KISSIMMEE FL
34741-5001
US

IV. Provider business mailing address

314 W BASS ST
KISSIMMEE FL
34741-5001
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax: 407-386-7448
Mailing address:
  • Phone: 321-445-1287
  • Fax: 407-386-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEAN BETOVEN MONTEIRO
Title or Position: OWNER
Credential:
Phone: 321-400-7527