| NPI | 1265144638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEENA JACKSON Owner/President 270-799-8662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2022-12-16 |