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General NPI Number Information
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NPI Number | 1548512072
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Entity Type | Individual
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Provider Name | MOLLI DONOVAN MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 8444 MOREHOUSE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5833
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Country | US
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Telephone | 740-352-6557
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Fax | 740-352-6557
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Provider Business Mailing Address
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Address Line | 8444 MOREHOUSE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5833
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Country | US
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Telephone | 740-352-6557
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Fax | 740-352-6557
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S7 5911
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA13005
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License Number State | FL
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