Healthcare Provider Details

I. General information

NPI: 1114726445
Provider Name (Legal Business Name): KOALATY SPEECH AND FEEDING THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 KRENSON OAKS ST
LAKELAND FL
33810-2160
US

IV. Provider business mailing address

6944 KRENSON OAKS ST
LAKELAND FL
33810-2160
US

V. Phone/Fax

Practice location:
  • Phone: 863-944-8940
  • Fax:
Mailing address:
  • Phone: 863-944-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARITY ELIZABETH BOBO
Title or Position: OWNER
Credential: CCC-SLP
Phone: 863-944-8940