MEDICARE: LEMON TREE REHABILITATIVE SERVICES LLC

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	:	1457189698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEMON TREE REHABILITATIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	200 RIVER OAKS DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-9278
Country	:	US
Telephone Number	:	904-704-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 INDIGO ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3763
Country	:	US
Telephone Number	:	904-704-5565
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE DESILET
Credential	:
Telephone Number	:	904-704-5565

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	10/16/2024

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