| NPI | 1114469640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA C WOOD Office Manager 662-772-5937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 225XP0200X Occupational Therapist, Pediatrics | |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-11-15 |