Provider Demographics
NPI:1083342620
Name:FUNDAMENTAL SPEECH THERAPY
Entity Type:Organization
Organization Name:FUNDAMENTAL SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-788-1739
Mailing Address - Street 1:6688 NOLESVILLE ROAD
Mailing Address - Street 2:STE 108-133
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:615-348-9991
Mailing Address - Fax:615-616-8725
Practice Address - Street 1:7049 SUNNYWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8624
Practice Address - Country:US
Practice Address - Phone:305-788-1739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty