MEDICARE: KASSIDY N OVERFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1083307276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIDY N OVERFIELD

Provider Business Mailing Address
First Line	:	46 VOLUSIA DR
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-3231
Country	:	US
Telephone Number	:	352-801-2976
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5227
Country	:	US
Telephone Number	:	352-801-2976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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Directions to “ KASSIDY N OVERFIELD ” Practice Location

Language	Start Address	Practice Location

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