Healthcare Provider Details

I. General information

NPI: 1023848850
Provider Name (Legal Business Name): MOLLY MEGAN REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 S APOPKA VINELAND RD STE 100
ORLANDO FL
32819-3151
US

IV. Provider business mailing address

2525 PASEO PARK RD UNIT 227-C
ORLANDO FL
32817-3306
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: