Organization
COLLABORATIVE FUNCTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMIE HANNA TISHKOFF M.A.CCC-SLP (PRES/VP/SEC. & SPEECH-LANGUAGE PATH)
(407) 540-1937
Entity
Organization
Contact information
Practice address
726 W COLONIAL DR, ORLANDO, FL 32804-7344
(407) 540-1937
(407) 540-1938
Mailing address
726 W COLONIAL DR, ORLANDO, FL 32804-7344
(407) 540-1937
(407) 540-1938
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT 5270
FL
235Z00000X
Speech-Language Pathologist
Primary
SA 2744
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
885998100
—
FL
Enumeration date
07/15/2006
Last updated
09/19/2008
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