Healthcare Provider Details

I. General information

NPI: 1588729859
Provider Name (Legal Business Name): FIRST STEPS PEDIATRIC THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD 509
CHARLOTTE NC
28207-2034
US

IV. Provider business mailing address

7017 PROVIDENCE RD S
WAXHAW NC
28173-7434
US

V. Phone/Fax

Practice location:
  • Phone: 704-491-1455
  • Fax: 704-256-4282
Mailing address:
  • Phone: 704-256-4281
  • Fax: 704-256-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number7633
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8271
License Number StateNC

VIII. Authorized Official

Name: MS. ROSEMARY DEMELLO
Title or Position: PRESIDENT-CLINICAL DIRECTOR
Credential: PT
Phone: 704-256-4281