Individual provider Active NPI

Mary Lou Oreolt

  • Speech-Language Pathologist
  • Fort Walton Beach, FL
National Provider Identifier
1972846145
Registry record updated Apr 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA 12164 Issued in FL
Practice address
2104 Lewis Turner Blvd
Complete Rehabilitation Services, Inc
Fort Walton Beach, FL 32547-1316
Phone
(850) 862-3728
Fax
(850) 862-6270
NPI assigned
Apr 5, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA 12164 FL Primary

Addresses

Primary practice location

2104 Lewis Turner Blvd
Complete Rehabilitation Services, Inc
Fort Walton Beach, FL 32547-1316

Mailing address

2104 Lewis Turner Blvd
Complete Rehabilitation Services, Inc
Fort Walton Beach, FL 32547-1316
Phone (850) 862-3728

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
SA 12164FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Speech Therapy Inc Speech-Language Pathologist CurrentSince May 1, 2023 Accepting new patients
Complete Rehabilitation Services, Inc. Speech-Language Pathologist Past Accepting new patients

Locations

160 N NC 241 Hwy
Beulaville, NC 28518
Phone (888) 258-6905

124 E Park Dr
Beulaville, NC 28518
Phone (888) 258-6905

1506 Wayne Memorial Dr
Ste F
Goldsboro, NC 27534
Phone (888) 258-6905

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1972846145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 LEWIS TURNER BLVD",
            "address_2": "COMPLETE REHABILITATION SERVICES, INC",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471316",
            "telephone_number": "850-862-3728",
            "fax_number": "850-862-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 LEWIS TURNER BLVD",
            "address_2": "COMPLETE REHABILITATION SERVICES, INC",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471316",
            "telephone_number": "850-862-3728",
            "fax_number": "850-862-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OREOLT",
        "first_name": "MARY",
        "middle_name": "LOU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-05",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 12164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; 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.