Provider Demographics
NPI:1235503723
Name:PAYNE, MATTHEW C (SLP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:PAYNE
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4559
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4559
Mailing Address - Country:US
Mailing Address - Phone:352-433-0091
Mailing Address - Fax:352-433-0676
Practice Address - Street 1:2801 SW COLLEGE RD
Practice Address - Street 2:STE 5
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7406
Practice Address - Country:US
Practice Address - Phone:352-433-0091
Practice Address - Fax:352-433-0607
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist