Healthcare Provider Details

I. General information

NPI: 1285380592
Provider Name (Legal Business Name): SMILEY PEDIATRIC SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 PHILLIP MORRIS DR STE 202
SALISBURY MD
21804-1964
US

IV. Provider business mailing address

224 PHILLIP MORRIS DR STE 202
SALISBURY MD
21804-1964
US

V. Phone/Fax

Practice location:
  • Phone: 443-422-2658
  • Fax: 443-498-2802
Mailing address:
  • Phone: 443-422-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JAIME L TONER
Title or Position: OWNER, SPEECH THERAPIST
Credential: MS, CCC-SLP
Phone: 443-422-2658