Basic Information
| Provider Information | |||||||||
| NPI: | 1972846145 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OREOLT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2104 LEWIS TURNER BLVD | ||||||||
| Address2: | COMPLETE REHABILITATION SERVICES, INC | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325471316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508623728 | ||||||||
| FaxNumber: | 8508626270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2104 LEWIS TURNER BLVD | ||||||||
| Address2: | COMPLETE REHABILITATION SERVICES, INC | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325471316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508623728 | ||||||||
| FaxNumber: | 8508626270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2013 | ||||||||
| LastUpdateDate: | 04/05/2013 | ||||||||
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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 12164 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.