Organization
SPEECH AND OCCUPATIONAL SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER OLESEN (OWNER)
(407) 399-6556
Entity
Organization
Contact information
Practice address
1201 WINTER GARDEN VINELAND RD STE 10, WINTER GARDEN, FL 34787-4380
(407) 654-5455
(407) 654-5829
Mailing address
12536 WESTFIELD LAKES CIR, WINTER GARDEN, FL 34787-5275
(407) 399-6556
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
FL
235Z00000X
Speech-Language Pathologist
SA9546
FL
261Q00000X
Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007154400
—
FL
05
—
007154401
—
FL
05
—
007154402
—
FL
01
—
HG468A
MEDICARE
FL
Enumeration date
09/25/2012
Last updated
06/16/2021
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