| NPI | 1700756418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM HICKMAN Director 855-907-0478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101200000X Drama Therapist |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery |
| 208D00000X General Practice | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2025-11-07 |
| Last Update Date | 2025-11-07 |