Healthcare Provider Details

I. General information

NPI: 1386407153
Provider Name (Legal Business Name): FIRM FOUNDATIONS PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST
SUMMERTON SC
29148-6904
US

IV. Provider business mailing address

1271 COTTAGE DR
SUMMERTON SC
29148-7008
US

V. Phone/Fax

Practice location:
  • Phone: 803-460-4655
  • Fax:
Mailing address:
  • Phone: 803-460-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA HALL YOUNT
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 803-460-4655