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General NPI Number Information
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NPI Number | 1164350013
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 46 WINDANCE DR
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City | CARRIERE
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State | MS
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Zip | 39426-7947
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Country | US
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Telephone | 985-502-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 46 WINDANCE DR
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City | CARRIERE
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State | MS
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Zip | 39426-7947
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Country | US
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Telephone | 985-502-3101
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGY
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Name | VICTORIA QUAVE MILEY
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Credential | CCC-SLP
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Telephone | 985-502-3101
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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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