Provider Demographics
NPI:1245488121
Name:SPEECH WORKS PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:SPEECH WORKS PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SOPHIE
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:386-405-3760
Mailing Address - Street 1:4077 N CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9326
Mailing Address - Country:US
Mailing Address - Phone:386-446-9935
Mailing Address - Fax:386-446-7777
Practice Address - Street 1:4 OFFICE PARK DR UNIT 400
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3821
Practice Address - Country:US
Practice Address - Phone:386-446-9935
Practice Address - Fax:386-446-7777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPEECH WORKS PEDIATRIC THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA5645OtherSTATE LICENSE