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General NPI Number Information
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NPI Number | 1720315211
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Entity Type | Organization
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Legal Business Name | HEADWAY THERAPY P.A.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 14717 YORKSHIRE RUN DR
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City | ORLANDO
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State | FL
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Zip | 32828-7831
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Country | US
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Telephone | 407-694-4366
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Fax | 407-249-2720
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Provider Business Mailing Address
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Address Line | 14717 YORKSHIRE RUN DR
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City | ORLANDO
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State | FL
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Zip | 32828-7831
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Country | US
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Telephone | 407-694-4366
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Fax | 407-249-2720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MICHAEL E QUINN II
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Credential | M.A., CCC-SLP
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Telephone | 407-694-4366
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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 | SA 6010
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License Number State | FL
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