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General NPI Number Information
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NPI Number | 1730732835
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Entity Type | Individual
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Provider Name | MARY O'GRADY
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1200 HAWTHORN HOUSE DR
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City | SHALIMAR
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State | FL
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Zip | 32579-1168
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Country | US
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Telephone | 850-380-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 808 PINE ALLEY ST
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1216
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Country | US
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Telephone | 850-380-2586
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA7
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License Number State | FL
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