| NPI | 1255622056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSI FUSTOS Founder 843-815-6999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: SC 3804) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |