| NPI | 1043976152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATLYN SHAW Owner 270-452-2835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 225XP0200X Occupational Therapist, Pediatrics | |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2022-10-18 |