NPIMap

Organization Active NPI

Atlantic Speech Therapy

  • Speech-Language Pathologist
  • Ponte Vedra, FL
National Provider Identifier
1053855452
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA 11834 Issued in FL
Legal business name
ATLANTIC SPEECH THERAPY
Practice address
145 Hilden Road #113
Ponte Vedra, FL 32081-5139
Phone
(904) 652-5408
Fax
(877) 652-5052
NPI assigned
Dec 5, 2016
Last updated
Mar 22, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ATLANTIC SPEECH THERAPYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jessica Beth Otto, MS. CCC-SLP
Title
Owner/Director
Phone
(904) 652-5408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA 11834 FL Primary

Addresses

Primary practice location

145 Hilden Road #113
Ponte Vedra, FL 32081-5139

Mailing address

11512 Lake Mead Ave
Suite 604
Jacksonville, FL 32256-9680
Phone (904) 652-5408

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Speech Therapy3 organizations share this tax ID, including this one
Part of
Atlantic Speech Therapy

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

145 Hilden Rd
Ste 113
Ponte Vedra Beach, FL 32081
Phone (904) 465-9062

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553212800000",
    "number": "1053855452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-652-5408",
            "fax_number": "877-652-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HILDEN ROAD #113",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815139",
            "telephone_number": "904-652-5408",
            "fax_number": "877-652-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC SPEECH THERAPY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTIC SPEECH THERAPY",
        "enumeration_date": "2016-12-05",
        "last_updated": "2019-03-22",
        "status": "A",
        "authorized_official_last_name": "OTTO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "904-652-5408",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 11834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.