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General NPI Number Information
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NPI Number | 1104503481
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Entity Type | Organization
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Legal Business Name | MILESTONE MASTERS PEDIATRIC THERAPY INC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 3543 EWELL ST
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City | ANNANDALE
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State | VA
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Zip | 22003-1708
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Country | US
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Telephone | 703-509-6109
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Fax |
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Provider Business Mailing Address
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Address Line | 3543 EWELL ST
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City | ANNANDALE
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State | VA
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Zip | 22003-1708
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Country | US
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Telephone | 703-509-6109
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LAUREN MICHELLE LYONS
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Credential | M. ED., CCC-SLP
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Telephone | 703-509-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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