Provider Demographics
NPI:1114987856
Name:OBROCHTA, ANGELA (MED CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OBROCHTA
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5519
Mailing Address - Country:US
Mailing Address - Phone:954-695-2521
Mailing Address - Fax:
Practice Address - Street 1:120 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1100
Practice Address - Country:US
Practice Address - Phone:954-561-0058
Practice Address - Fax:954-563-2558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist