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General NPI Number Information
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NPI Number | 1083342620
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Entity Type | Organization
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Legal Business Name | FUNDAMENTAL SPEECH THERAPY
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 7049 SUNNYWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37211-8624
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Country | US
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Telephone | 305-788-1739
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Fax |
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Provider Business Mailing Address
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Address Line | 6688 NOLESVILLE ROAD STE 108-133
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City | BRENTWOOD
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State | TN
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Zip | 37027-8833
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Country | US
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Telephone | 615-348-9991
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Fax | 615-616-8725
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MELISSA OLIVA
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Credential | MS, CCC-SLP
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Telephone | 305-788-1739
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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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