Healthcare Provider Details

I. General information

NPI: 1225515257
Provider Name (Legal Business Name): SPEECH BY THE BEACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 HWY 9E SUITE C4
LONGS SC
29568-5753
US

IV. Provider business mailing address

2126 HWY 9E SUITE C4
LONGS SC
29568-5753
US

V. Phone/Fax

Practice location:
  • Phone: 843-734-1076
  • Fax: 843-734-1107
Mailing address:
  • Phone: 843-734-1076
  • Fax: 843-734-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LORI S. LEGGETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-734-1076