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Organization

IMPACT THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLY QUIN PREJEAN MA, CCC-SLP (CLINIC DIRECTOR)
(850) 325-6301
Entity
Organization

Contact information

Practice address
1725 HERMITAGE BLVD, TALLAHASSEE, FL 32308-7709
(850) 325-6301
(850) 325-6302
Mailing address
1717 HERMITAGE BLVD, TALLAHASSEE, FL 32308-7709
(850) 325-6301
(850) 325-6302

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT10243
FL

Other

Enumeration date
10/15/2006
Last updated
06/26/2024
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