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General NPI Number Information
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NPI Number | 1114943594
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE FUNCTION
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 726 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32804-7344
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Country | US
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Telephone | 407-540-1937
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Fax | 407-540-1938
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Provider Business Mailing Address
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Address Line | 726 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32804-7344
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Country | US
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Telephone | 407-540-1937
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Fax | 407-540-1938
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Authorized Official
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Title or Position | PRES/VP/SEC. & SPEECH-LANGUAGE PATH
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Name | MS. AMIE HANNA TISHKOFF
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Credential | M.A.CCC-SLP
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Telephone | 407-540-1937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 5270
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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 | SA 2744
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License Number State | FL
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