Provider Demographics
NPI:1578906103
Name:HART, DEBORAH MIRIAM
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MIRIAM
Last Name:HART
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 1:1229 LA FAUNCE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1626
Mailing Address - Country:US
Mailing Address - Phone:239-823-4592
Mailing Address - Fax:
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9322
Practice Address - Country:US
Practice Address - Phone:239-479-5093
Practice Address - Fax:239-479-5094
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist