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General NPI Number Information
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NPI Number | 1124310453
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Entity Type | Organization
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Legal Business Name | ON THE SPOT SPEECH THERAPY
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 5313 PALEO PINES CIR
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City | FORT PIERCE
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State | FL
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Zip | 34951-2344
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Country | US
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Telephone | 772-226-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 5313 PALEO PINES CIR
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City | FORT PIERCE
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State | FL
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Zip | 34951-2344
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Country | US
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Telephone | 772-577-3806
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ELIZABETH PORTEUS
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Credential | M.S. CCC-SLP
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Telephone | 301-573-3158
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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 | 05704
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License Number State | MD
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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 | SL010271
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA11437
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License Number State | FL
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