Provider Demographics
NPI:1316176522
Name:FURMAN, MARILON GAIL
Entity type:Individual
Prefix:MS
First Name:MARILON
Middle Name:GAIL
Last Name:FURMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 LAKE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-8769
Mailing Address - Country:US
Mailing Address - Phone:813-949-1381
Mailing Address - Fax:
Practice Address - Street 1:1628 LAKE HERON DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-8769
Practice Address - Country:US
Practice Address - Phone:813-949-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist