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General NPI Number Information
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NPI Number | 1255005203
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Entity Type | Organization
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Legal Business Name | LIVE, LEARN, GROW - PEDIATRIC THERAPY SOLUTIONS, LLC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 906 TETBURY PL
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City | BRANDON
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State | MS
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Zip | 39047-9274
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Country | US
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Telephone | 662-820-8732
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Fax | 601-202-9606
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Provider Business Mailing Address
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Address Line | 906 TETBURY PL
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City | BRANDON
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State | MS
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Zip | 39047-9274
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Country | US
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Telephone | 662-820-8732
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Fax | 601-202-9606
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA NICHOLS
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Credential | OT
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Telephone | 662-820-8732
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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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