Healthcare Provider Details

I. General information

NPI: 1508788803
Provider Name (Legal Business Name): MUSTARD SEED THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOLE IN ONE DR
HAYESVILLE NC
28904-1087
US

IV. Provider business mailing address

240 HOLE IN ONE DR
HAYESVILLE NC
28904-1087
US

V. Phone/Fax

Practice location:
  • Phone: 646-309-5338
  • Fax:
Mailing address:
  • Phone: 646-309-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARCELLINE LEA FUERCH
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: M.A. CCC-SLP
Phone: 646-309-5338