Basic Information
Provider Information
NPI: 1376018218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASALI
FirstName: MARTINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3325 N UNIVERSITY DR
Address2:  
City: CORAL SPRINGS
State: FL
PostalCode: 330654162
CountryCode: US
TelephoneNumber: 9543446550
FaxNumber:  
Practice Location
Address1: 2736 HOLLYWOOD BLVD
Address2:  
City: HOLLYWOOD
State: FL
PostalCode: 330204808
CountryCode: US
TelephoneNumber: 9546031881
FaxNumber: 9546035341
Other Information
ProviderEnumerationDate: 10/08/2018
LastUpdateDate: 08/26/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  N    
2355S0801XSI3955FLY Speech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant

No ID Information.


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