MEDICARE: TARA BOMBE M.A., CF-SLP

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	235Z00000X	Speech-Language Pathologist	SZ6231	FL

General Provider Information

NPI Number	:	1124466818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BOMBE M.A., CF-SLP

Provider Business Mailing Address
First Line	:	1200 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4986
Country	:	US
Telephone Number	:	407-271-4911
Fax Number	:	407-264-8344

Provider Business Practice Location Address
First Line	:	1200 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4986
Country	:	US
Telephone Number	:	407-271-4911
Fax Number	:	407-264-8344

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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