Healthcare Provider Details

I. General information

NPI: 1841954351
Provider Name (Legal Business Name): AUTISM THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 OLMSTED BLVD STE 7
PINEHURST NC
28374-8730
US

IV. Provider business mailing address

568 SANDHURST DR
FAYETTEVILLE NC
28304-4426
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TERRA RAE SCOTT
Title or Position: SVP OUTPATIENT PEDIATRICS
Credential:
Phone: 303-437-4364