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General NPI Number Information
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NPI Number | 1215387956
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Entity Type | Organization
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Legal Business Name | TINY PALMS SPEECH THERAPY
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 5625 GOLDEN EAGLE CIR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-1521
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Country | US
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Telephone | 954-604-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 GOLDEN EAGLE CIR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-1521
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Country | US
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Telephone | 954-604-1085
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SPEECH PATHOLOGIST
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Name | CARLA RODRIGUEZ
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Credential | MS. CCC-SLP
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Telephone | 954-604-1085
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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 | SA12319
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License Number State | FL
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