| NPI | 1164941662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY ANN LOPEZ Administrator 407-250-0626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2019-10-09 |