Provider Demographics
NPI:1396306874
Name:TRI-COUNTY SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPIES
Entity type:Organization
Organization Name:TRI-COUNTY SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-228-4192
Mailing Address - Street 1:1502 N DONNELLY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2846
Mailing Address - Country:US
Mailing Address - Phone:352-729-2277
Mailing Address - Fax:
Practice Address - Street 1:1502 N DONNELLY ST STE 109
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2846
Practice Address - Country:US
Practice Address - Phone:352-729-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty