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General NPI Number Information
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NPI Number | 1073788691
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Entity Type | Organization
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Legal Business Name | WEST ORANGE SPEECH PATHOLOGIST, INC.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 6388 SILVER STAR RD STE 2E
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City | ORLANDO
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State | FL
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Zip | 32818-3235
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Country | US
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Telephone | 407-298-5300
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Fax | 407-296-0026
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Provider Business Mailing Address
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Address Line | PO BOX 555907
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City | ORLANDO
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State | FL
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Zip | 32855-5907
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Country | US
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Telephone | 407-298-5300
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Fax | 407-296-0026
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Authorized Official
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Title or Position | CEO/SLP
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Name | MRS. LINDA TATUM-RILEY
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Credential | M.S. CCC-SLP
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Telephone | 407-298-5300
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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 | SA1245
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License Number State | FL
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