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General NPI Number Information
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NPI Number | 1225207111
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Entity Type | Organization
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Legal Business Name | LEIGH EARLE
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 500 23RD AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-4318
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Country | US
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Telephone | 727-244-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 500 23RD AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-4318
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Country | US
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Telephone | 727-244-6502
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. LEIGH EARLE
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Credential | M.S., CCC-SLP
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Telephone | 727-244-6502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | SA 5532
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License Number State | FL
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