| NPI | 1033593785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN PAUL CISCO Owner 423-476-7212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2022-07-08 |