| NPI | 1891256251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY A CARRICO Owner 270-926-2212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 261QR0400X Clinic/Center Rehabilitation | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2021-12-10 |