Healthcare Provider Details

I. General information

NPI: 1477208502
Provider Name (Legal Business Name): RIGHT LEAD THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TN 226
SAVANNAH TN
38372
US

IV. Provider business mailing address

65 SHANNON LN
COUNCE TN
38326-2044
US

V. Phone/Fax

Practice location:
  • Phone: 731-438-1140
  • Fax:
Mailing address:
  • Phone: 731-438-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN BROOK BALLARD
Title or Position: OWNER
Credential: COTA/L
Phone: 731-438-1140