MEDICARE: LISA SABIN MA,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	SA10887	FL

General Provider Information

NPI Number	:	1164793287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SABIN MA,CCC,SLP

Provider Business Mailing Address
First Line	:	1145 COLLINS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8440
Country	:	US
Telephone Number	:	386-956-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 COLLINS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8440
Country	:	US
Telephone Number	:	386-956-0777
Fax Number	:

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

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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