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General NPI Number Information
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NPI Number | 1235477944
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Entity Type | Organization
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Legal Business Name | GREEN APPLE THERAPY
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 23005 NW 11TH RD
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City | NEWBERRY
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State | FL
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Zip | 32669-1911
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Country | US
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Telephone | 352-256-5072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 359064
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City | GAINESVILLE
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State | FL
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Zip | 32635-9016
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Country | US
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Telephone | 352-256-5072
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN R SHEPARD
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Credential | CCC/SLP
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Telephone | 352-256-5072
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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 | SA9491
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License Number State | FL
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