MEDICARE: AMY L THORNTON M.S.,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	SA11718	FL

General Provider Information

NPI Number	:	1770950248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L THORNTON M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	138 SANDESTIN LN
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-5815
Country	:	US
Telephone Number	:	850-267-2887
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 SANDESTIN LN
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-5815
Country	:	US
Telephone Number	:	850-267-2887
Fax Number	:

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

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	01/05/2016

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