MEDICARE: FLORIDA ALLIANCE FOR ASSISTIVE SERVICES AND TECHNOLOGY

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1770946576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA ALLIANCE FOR ASSISTIVE SERVICES AND TECHNOLOGY

Provider Business Mailing Address
First Line	:	3333 W PENSACOLA ST
Second Line	:	STE 140
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-2888
Country	:	US
Telephone Number	:	850-487-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 W PENSACOLA ST
Second Line	:	STE 140
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-2888
Country	:	US
Telephone Number	:	850-487-3278
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL J DANIELS
Credential	:
Telephone Number	:	850-487-3278

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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