MEDICARE: COCO'S SPEECH THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1831836113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCO'S SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 403
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-0403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E BUTLER RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5866
Country	:	US
Telephone Number	:	843-230-7966
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KANISHA MCCREA
Credential	:
Telephone Number	:	843-230-7966

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	06/28/2022

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Directions to “COCO'S SPEECH THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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