Individual
MARISSA GUAGLIARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
Mailing address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
SI1840
FL
2355S0801X
Speech-Language Assistant
SI1840
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006712400
—
FL
Enumeration date
08/02/2010
Last updated
10/22/2012
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