Provider Demographics
NPI:1487913018
Name:BRANSON, PAGE STRICKLAND
Entity type:Individual
Prefix:MRS
First Name:PAGE
Middle Name:STRICKLAND
Last Name:BRANSON
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 1:1607 SE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4645
Mailing Address - Country:US
Mailing Address - Phone:352-351-5871
Mailing Address - Fax:
Practice Address - Street 1:1607 SE 13TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4645
Practice Address - Country:US
Practice Address - Phone:352-351-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist