Healthcare Provider Details

I. General information

NPI: 1922358332
Provider Name (Legal Business Name): CREATIVE SPEECH SOLUTIONS & THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BELLA VIDA BLVD
ORLANDO FL
32828-6717
US

IV. Provider business mailing address

PO BOX 781577
ORLANDO FL
32878-1577
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-3489
  • Fax: 407-386-6062
Mailing address:
  • Phone: 321-961-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NIKA PALCESKI
Title or Position: MANAGING MEMBER
Credential:
Phone: 407-252-4651