=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073810347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHATTERBOX THERAPY GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2011
-----------------------------------------------------
Last Update Date | 06/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5199 DERBY FOREST LN
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32258-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-465-3756
-----------------------------------------------------
Fax | 904-262-5773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5199 DERBY FOREST LN
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32258-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-465-3756
-----------------------------------------------------
Fax | 904-262-5773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | URMIL KAMAL PAREKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-465-3756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA5993
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | SA5993
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------