| NPI | 1205566528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CAMILLE JOHNSON Executive Director 737-781-3946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 225XP0200X Occupational Therapist, Pediatrics | |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2024-02-14 |