| NPI | 1447035068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BOYINGTON Owner/Member 262-262-6065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |