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General NPI Number Information
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NPI Number | 1801177696
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Entity Type | Organization
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Legal Business Name | CHARTER THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 905 E MARTIN LUTHER KING JR DR SUITE 400
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4864
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Country | US
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Telephone | 727-207-7271
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Fax |
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Provider Business Mailing Address
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Address Line | 905 E MARTIN LUTHER KING JR DR STE 400 SUITE 400
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4829
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Country | US
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Telephone | 727-207-7271
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JUSTINE NELSON
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Credential | MS, CCC-SLP
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Telephone | 727-207-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SA 11077
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License Number State | FL
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