| NPI | 1922883453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN VISTARAKULA Owner 540-315-3210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist Pediatrics |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |