MEDICARE: PALM PEDIATRIC THERAPY

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1164865531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	158 BATH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11911 US HIGHWAY 1 STE 102
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-2872
Country	:	US
Telephone Number	:	561-694-7661
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. ANASTASIYA MARARENKO
Credential	:	M.S., CF-SLP
Telephone Number	:	347-751-9462

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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Directions to “PALM PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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