| NPI | 1265019699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACY WICKERSON Owner 704-258-7031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-11-06 |