Healthcare Provider Details

I. General information

NPI: 1114706181
Provider Name (Legal Business Name): NURTURING WONDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 S LIVE OAK DR
MONCKS CORNER SC
29461-7230
US

IV. Provider business mailing address

237 LUCCA DR
SUMMERVILLE SC
29486-8416
US

V. Phone/Fax

Practice location:
  • Phone: 843-879-8471
  • Fax:
Mailing address:
  • Phone: 559-940-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS SALAZAR
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 559-940-9061