| NPI | 1841025657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STREETER Chief Administrative Officer 800-699-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 103T00000X Psychologist |
| 2251P0200X Physical Therapist Pediatrics | |
| 225XP0200X Occupational Therapist Pediatrics | |
| 235Z00000X Speech-Language Pathologist | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |