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General NPI Number Information
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NPI Number | 1356785653
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Entity Type | Organization
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Legal Business Name | BONAVOX THERAPIES INC.
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 4033 IBIS DR
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City | ORLANDO
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State | FL
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Zip | 32803-3043
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Country | US
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Telephone | 407-776-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 4033 IBIS DR
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City | ORLANDO
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State | FL
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Zip | 32803-3043
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Country | US
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Telephone | 407-776-6631
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | MRS. DIETRA KATHY VON TABORSKY
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Credential | M.A.CCC-SLP
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Telephone | 407-766-6315
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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 | SA9486
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License Number State | FL
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