=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891141461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEELE THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2016
-----------------------------------------------------
Last Update Date | 05/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 NW 73RD TER
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-218-0806
-----------------------------------------------------
Fax | 754-779-7859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 NW 73RD TER
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-218-0806
-----------------------------------------------------
Fax | 754-779-7859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY STEELE
-----------------------------------------------------
Credential | M.S.CCC-SLP, C/NDT
-----------------------------------------------------
Telephone | 954-218-0806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA12568
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------