| NPI | 1851950414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY HERBOTH Owner 618-322-5493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-06-07 |