| NPI | 1053967273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCKY FERGUSON Managing Partner 224-201-8769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 104100000X Social Worker |
| 235Z00000X Speech-Language Pathologist, | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2024-02-16 |