=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871990887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLP MIAMI THERAPY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2014
-----------------------------------------------------
Last Update Date | 11/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12516 SW 124 PATH
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-562-1658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12516 SW 124 PATH
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-562-1658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. MARIA DEL PILAR TORMO
-----------------------------------------------------
Credential | M.S., CCC/SLP
-----------------------------------------------------
Telephone | 305-562-0598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA11963
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------