| NPI | 1417475898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI SOPER Director 276-806-0662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202004244) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2017-09-21 |