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General NPI Number Information
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NPI Number | 1053080382
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Entity Type | Organization
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Legal Business Name | DANDELION PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 125 STILLHOUSE CREEK DR
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City | MADISON
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State | MS
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Zip | 39110-6943
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Country | US
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Telephone | 601-826-2609
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415
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City | MADISON
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State | MS
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Zip | 39130-0415
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Country | US
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Telephone | 601-826-2609
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. ASHLEY NICOLE BUCK
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Credential | MS, OTR/L
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Telephone | 601-826-2609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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