Healthcare Provider Details

I. General information

NPI: 1609794197
Provider Name (Legal Business Name): MILESTONE MAKERS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CASSIA CT
COLUMBIA SC
29209-4226
US

IV. Provider business mailing address

15 CASSIA CT
COLUMBIA SC
29209-4226
US

V. Phone/Fax

Practice location:
  • Phone: 631-413-6678
  • Fax:
Mailing address:
  • Phone: 631-413-6678
  • 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: MS. ALEXA L KIESLING
Title or Position: OWNER
Credential: M.S CCC-SLP
Phone: 631-413-6678