| Doctor Name: | MARY MILLER TATUM |
| NPI Number: | 1700107448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED, CCC-SLP |
| License Number: | SA11089 |
| Business Practice Address: | 122 Eglin Pkwy Ne Fort Walton Beach, FL - 325484917 |
| Business Phone Number: | 8508639973 |
| Business Fax Number: | 8508639974 |
| Mailing Address: | 122 Eglin Pkwy Ne, FORT WALTON BEACH |
| State: | FL |
| Postal Code: | 325484917 |
| Phone Number: | 8508639973 |
| Fax Number: | 8508639974 |
| NPI Enumeration Date: | 06/16/2010 |
| NPI Last Update Date: | 09/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA11089 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |