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General NPI Number Information
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NPI Number | 1114442969
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Entity Type | Individual
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Provider Name | EMILY PAIGE MITCHELL O'BRIEN MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2017
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 5203 MERION RD
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City | VALRICO
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State | FL
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Zip | 33596-8266
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Country | US
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Telephone | 813-716-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 HOT SPRING LN
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-3721
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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 |
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Name |
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Credential |
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Telephone |
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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 | SA19141
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202008587
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License Number State | VA
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