Basic Information
| Provider Information | |||||||||
| NPI: | 1407036403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | MARIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15030 CEDAR BRANCH WAY | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328244601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072346394 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 448 W DONEGAN AVE | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347412335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079323445 | ||||||||
| FaxNumber: | 4079323480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 9264 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SA 9264 | 01 | FL | SLP LICENSE | OTHER | 892565800 | 05 | FL | MEDICAID |