Active NPI
Mary Brent Watson, SLP
- Speech-Language Pathologist
- Orlando, FL
National Provider Identifier
1912179409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA4494
- Practice address
- 1525 S Alafaya TRL
Suite 101
Orlando, FL 32828-8926 - Phone
- (407) 384-2767
- Fax
- (407) 382-5637
- NPI assigned
- Mar 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA4494 | FL | Primary |
| Developmental Therapist | 222Q00000X |
Addresses
Primary practice location
1525 S Alafaya TRL
Suite 101
Orlando, FL 32828-8926
Mailing address
1626 White Dove Dr
Winter Springs, FL 32708-3893
Phone (407) 366-6297
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 883958100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA4494 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307577600000",
"number": "1912179409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1626 WHITE DOVE DR",
"city": "WINTER SPRINGS",
"state": "FL",
"postal_code": "327083893",
"telephone_number": "407-366-6297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 S ALAFAYA TRL",
"address_2": "SUITE 101",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328288926",
"telephone_number": "407-384-2767",
"fax_number": "407-382-5637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "MARY",
"middle_name": "BRENT",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-25",
"last_updated": "2011-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA4494",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "883958100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.