Healthcare Provider Details

I. General information

NPI: 1174239487
Provider Name (Legal Business Name): BUMBLEBEE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 50TH ST NW STE 102
WASHINGTON DC
20016-4394
US

IV. Provider business mailing address

4301 50TH ST NW STE 102
WASHINGTON DC
20016-4394
US

V. Phone/Fax

Practice location:
  • Phone: 202-384-6594
  • Fax:
Mailing address:
  • Phone: 202-384-6594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEX EMILY KOLLER
Title or Position: OWNER, SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 202-384-6594