Healthcare Provider Details

I. General information

NPI: 1942286372
Provider Name (Legal Business Name): PEDIATRIC THERAPLAY SPEECH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2005
Last Update Date: 12/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 LINDEN BERRY LN
CHARLOTTE NC
28269-1300
US

IV. Provider business mailing address

PO BOX 480462
CHARLOTTE NC
28269-5320
US

V. Phone/Fax

Practice location:
  • Phone: 704-258-1724
  • Fax: 704-598-3024
Mailing address:
  • Phone: 704-258-1724
  • Fax: 704-598-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. WENDY YOSHINO TEAL
Title or Position: PRESIDENT
Credential: CCC-SLP
Phone: 704-258-1724