# FUNCTIONAL ORAL MOTOR AND FEEDING CONCEPTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952665416
- **Authorized official:** MRS. KIMBERLY A GRIFFITH SLP (OWNER/PROVIDER)
- **Authorized official phone:** (260) 438-3586

## Contact information

- **Practice address:** 6205 CONSTITUTION DR, FORT WAYNE, IN 46804-1517
- **Practice address phone:** (260) 438-3586
- **Practice address fax:** (260) 432-7046
- **Mailing address:** 6025 CONSTITUTION DR, FORT WAYNE, IN 46804
- **Mailing address phone:** (260) 438-3586
- **Mailing address fax:** (260) 432-7046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 235Z00000X | Speech-Language Pathologist | — | IN | Yes |

## Other

- **Enumeration date:** 06/29/2012
- **Last updated:** 10/12/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200681320A | — | IN |