MEDICARE: APPLES AND BANANAS PEDIATRIC ORAL MOTOR AND DYSPHAGIA CENTER

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	16446	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1376662064	OTHER	TX	NPI (INDIVIDUAL)

General Provider Information

NPI Number	:	1649470030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLES AND BANANAS PEDIATRIC ORAL MOTOR AND DYSPHAGIA CENTER

Provider Business Mailing Address
First Line	:	3154 BONNEY BRIAR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3113
Country	:	US
Telephone Number	:	713-545-0349
Fax Number	:

Provider Business Practice Location Address
First Line	:	3154 BONNEY BRIAR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3113
Country	:	US
Telephone Number	:	713-545-0349
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. SHANNON LEWIS SERVANCE
Credential	:	M.A. CCC-SLP
Telephone Number	:	713-545-0349

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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Directions to “APPLES AND BANANAS PEDIATRIC ORAL MOTOR AND DYSPHAGIA CENTER ” Practice Location

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