Individual
MRS. CELIS MARIE ROMAN-OTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
6035 PEACHTREE RD STE C120, DORAVILLE, GA 30360-3234
(678) 514-3270
Mailing address
URB MONTE MAYOR, 563 FLAMENCO STREET, DORADO, PR 00646
(787) 376-4905
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
010375
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R553-113-71-804-0
DRIVER LICENSE
FL
Enumeration date
05/15/2019
Last updated
05/15/2019
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