| NPI | 1801137674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE MELISSA SUMNER DAVIS Owner 772-257-6962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA12097) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: FL SA12097) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2019-09-26 |