| NPI | 1508270505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT YATES Member 931-510-8832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist Pediatrics (Licence: TN 4058) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: TN 3389) |
| 225XP0200X Occupational Therapist Pediatrics (Licence: TN 3741) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2014-06-17 |