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General NPI Number Information
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NPI Number | 1124394788
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Entity Type | Individual
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Provider Name | JAMIE LEE MCCULLERS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1120 W DONEGAN AVE
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City | KISSIMMEE
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State | FL
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Zip | 34741-2247
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Country | US
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Telephone | 407-847-2854
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 E ESTHER ST
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City | ORLANDO
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State | FL
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Zip | 32806-4124
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Country | US
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Telephone | 239-980-0812
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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 | SZ 5740
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License Number State | FL
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