| NPI | 1376256875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY TUCKER Co Owner 870-974-9114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |