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General NPI Number Information
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NPI Number | 1063134542
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Entity Type | Organization
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Legal Business Name | OLIVE TREE SPEECH THERAPY
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 4709 SE 102ND PL UNIT 2-104
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City | BELLEVIEW
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State | FL
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Zip | 34420-2939
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Country | US
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Telephone | 352-659-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 5707 SE 116TH ST
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City | BELLEVIEW
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State | FL
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Zip | 34420-4327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | SHAIMIR BERRIOS RODRIGUEZ
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Credential |
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Telephone | 786-553-4889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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