Provider Demographics
NPI:1851509285
Name:ABITBOL, MOLLY (SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ABITBOL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 TOWN CENTER RD STE 10
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1026
Mailing Address - Country:US
Mailing Address - Phone:561-613-3037
Mailing Address - Fax:
Practice Address - Street 1:5458 TOWN CENTER RD STE 10
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1026
Practice Address - Country:US
Practice Address - Phone:561-613-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890590800Medicaid