=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073848172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAVES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2009
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 W MAIN ST STE 104
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-3786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-794-9602
-----------------------------------------------------
Fax | 615-791-9179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 W MAIN ST STE 104
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-3786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-794-9602
-----------------------------------------------------
Fax | 615-791-9179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STACI DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-786-1705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | L000000005184
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------