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General NPI Number Information
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NPI Number | 1336613769
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Entity Type | Individual
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Provider Name | MATTHEW COMER
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 2129 W NEW HAVEN AVE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3875
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Country | US
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Telephone | 321-676-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 245 CAHABA VALLEY PKWY STE 200
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City | PELHAM
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State | AL
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Zip | 35124-2217
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Country | US
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Telephone | 205-942-6820
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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 | SA10385
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License Number State | FL
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