Healthcare Provider Details

I. General information

NPI: 1245647858
Provider Name (Legal Business Name): OLIVIA ZICCHINELLI M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: O.C. ZICCHINELLI DBA SUPER-KIDS INTERACTIVE INC

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 WINFIELD BLVD # 223D
MARGATE FL
33063-7169
US

IV. Provider business mailing address

6503 WINFIELD BLVD # 223D
MARGATE FL
33063-7169
US

V. Phone/Fax

Practice location:
  • Phone: 954-254-4437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA1339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: