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General NPI Number Information
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NPI Number | 1114726445
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Entity Type | Organization
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Legal Business Name | KOALATY SPEECH AND FEEDING THERAPY SERVICES LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 6944 KRENSON OAKS ST
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City | LAKELAND
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State | FL
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Zip | 33810-2160
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Country | US
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Telephone | 863-944-8940
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Fax |
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Provider Business Mailing Address
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Address Line | 6944 KRENSON OAKS ST
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City | LAKELAND
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State | FL
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Zip | 33810-2160
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Country | US
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Telephone | 863-944-8940
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARITY ELIZABETH BOBO
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Credential | CCC-SLP
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Telephone | 863-944-8940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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