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General NPI Number Information
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NPI Number | 1669833182
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Entity Type | Organization
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Legal Business Name | SPEECH REHABILITATION SERVICES
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 1528 AVONDALE RIDGE DR
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City | PLANT CITY
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State | FL
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Zip | 33567-3682
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Country | US
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Telephone | 813-431-7064
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Fax | 813-704-5341
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Provider Business Mailing Address
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Address Line | 1528 AVONDALE RIDGE DR
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City | PLANT CITY
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State | FL
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Zip | 33567-3682
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Country | US
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Telephone | 813-431-7064
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Fax | 813-704-5341
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Authorized Official
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Title or Position | OWNER
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Name | DR. TANDRIA MILAGNO CALLINS
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Credential | PH.D., CCC-SLP
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Telephone | 813-431-7064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | SA7606
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License Number State | FL
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