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General NPI Number Information
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NPI Number | 1326298928
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Entity Type | Individual
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Provider Name | MARTINE VANRYCKEGHEM PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 12424 RESEARCH PKWY SUITE 155
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City | ORLANDO
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State | FL
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Zip | 32826-3249
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Country | US
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Telephone | 407-882-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 832 BENTLEY GREEN CIR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-4349
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Country | US
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Telephone | 407-365-4117
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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 | SA5033
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License Number State | FL
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