Basic Information
| Provider Information | |||||||||
| NPI: | 1215515721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CENTER FOR DISCOVERING ABILITIES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1279 NE 29TH TER | ||||||||
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| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349574885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039218140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1279 NE 29TH TER | ||||||||
| Address2: | |||||||||
| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349574885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039218140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2021 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | PAUL | ||||||||
| AuthorizedOfficialFirstName: | ABIGAIL | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3039218140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, CCC-SLP | ||||||||
| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XE0001X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 051981400 | 05 | FL | MEDICAID | SA14062 | 01 | FL | FLORIDA DEPARTMENT OF HEALTH SLP LICENSE NUMBER | OTHER |