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General NPI Number Information
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NPI Number | 1174841779
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Entity Type | Organization
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Legal Business Name | CHILD DEVELOPMENTAL THERAPY, INC.
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 5806 MARYMAN RD
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City | LOUISVILLE
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State | KY
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Zip | 40258-2002
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Country | US
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Telephone | 502-592-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 5806 MARYMAN RD
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City | LOUISVILLE
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State | KY
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Zip | 40258-2002
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Country | US
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Telephone | 502-592-9936
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Fax |
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | MS. MYRA BRUTON TAYLOR
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Credential | MS
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Telephone | 502-592-9936
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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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