| NPI | 1205485463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA SHAW Owner 678-540-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2022-10-27 |