Basic Information
| Provider Information | |||||||||
| NPI: | 1184376386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNCOAST PEDIATRIC THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16748 FAIRBOLT WAY | ||||||||
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| City: | ODESSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335566031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126749776 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16748 FAIRBOLT WAY | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335566031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126749776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2022 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | LAMB | ||||||||
| AuthorizedOfficialFirstName: | DEANNA | ||||||||
| AuthorizedOfficialMiddleName: | CARREIRA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 9126749776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.ED. CCC-SLP | ||||||||
| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.