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General NPI Number Information
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NPI Number | 1912179409
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Entity Type | Individual
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Provider Name | MARY BRENT WATSON SLP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 1525 S ALAFAYA TRL SUITE 101
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City | ORLANDO
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State | FL
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Zip | 32828-8926
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Country | US
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Telephone | 407-384-2767
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Fax | 407-382-5637
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Provider Business Mailing Address
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Address Line | 1626 WHITE DOVE DR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-3893
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Country | US
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Telephone | 407-366-6297
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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 | SA4494
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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