MEDICARE: RACHEL NICHOLE BRYANT CCC-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

General Provider Information

NPI Number	:	1154624690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL NICHOLE BRYANT CCC-SLP

Provider Business Mailing Address
First Line	:	7390 SPARKLING LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4741
Country	:	US
Telephone Number	:	321-320-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	7390 SPARKLING LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4741
Country	:	US
Telephone Number	:	321-320-1769
Fax Number	:

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

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	07/30/2019

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