=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235499971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORDPLAY SPEECH-LANGUAGE THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2012
-----------------------------------------------------
Last Update Date | 08/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2255 GRANDIN RD SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24015-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-521-5920
-----------------------------------------------------
Fax | 888-658-8663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2255 GRANDIN RD SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24015-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-521-5920
-----------------------------------------------------
Fax | 888-658-8663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MICHELLE NERVO SCARFE
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 540-521-5920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 2202005130
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------