Individual
MRS. AFTON D THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12220 TOWNE LAKE DR, STE 1, FORT MYERS, FL 33913
(239) 433-6700
(239) 433-6703
Mailing address
12220 TOWNE LAKE DR, STE 1, FORT MYERS, FL 33913
(239) 433-6700
(239) 433-6703
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
222Q00000X
Developmental Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SA12565
FL
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009427500
—
FL
Enumeration date
06/01/2012
Last updated
04/27/2026
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