Matthew Omalley, SLPA, ITDS

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

SI3849 Issued in FL

Practice address

201 Thornberry Branch LN
Daytona Beach, FL 32124-3652

Phone

(317) 340-9490

NPI assigned

May 7, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1457916215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 DOMENICO CIR UNIT C14",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320867813",
            "telephone_number": "317-340-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 THORNBERRY BRANCH LN",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321243652",
            "telephone_number": "317-340-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMALLEY",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "SLPA, ITDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "FL",
            "license": "SI3849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Assistant in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Speech-Language Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.