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General NPI Number Information
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NPI Number | 1669894176
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Entity Type | Individual
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Provider Name | FALLON FRISCHE
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Gender | Female
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 6867 SOUTHPOINT DR N STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8005
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Country | US
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Telephone | 904-619-6971
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Fax |
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Provider Business Mailing Address
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Address Line | 13700 RICHMOND PARK DR N APT 501
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City | JACKSONVILLE
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State | FL
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Zip | 32224-4274
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Country | US
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Telephone |
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | F620-241-87-505-1
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License Number State | FL
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