1154634202 NPI number — CAPE COD SPEECH AND LANGUAGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154634202 NPI number — CAPE COD SPEECH AND LANGUAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPE COD SPEECH AND LANGUAGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154634202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 774
Provider Second Line Business Mailing Address:
46 MAIN STREET
Provider Business Mailing Address City Name:
ORLEANS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02653-0774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-255-0076
Provider Business Mailing Address Fax Number:
888-317-8302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 MAIN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
ORLEANS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02653-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-255-0076
Provider Business Practice Location Address Fax Number:
888-317-8302
Provider Enumeration Date:
07/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TIMMONS
Authorized Official First Name:
MAE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SPEECH PATHOLOGIST
Authorized Official Telephone Number:
508-255-0076

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  1436 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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