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General NPI Number Information
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NPI Number | 1043966492
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Entity Type | Organization
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Legal Business Name | DAISY PEDIATRIC SPEECH THERAPY SERVICES
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 10 MAST COURT
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City | PORTSMOUTH
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State | VA
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Zip | 23703
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Country | US
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Telephone | 757-997-2537
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Fax | 757-432-3227
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Provider Business Mailing Address
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Address Line | 5705 LYNNHAVEN PKWY STE 104 PMB 1227
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8533
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Country | US
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Telephone | 757-632-2456
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. KIE'RRA T. LOFTIN
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Credential | MA. CCC-SLP
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Telephone | 757-632-2456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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