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General NPI Number Information
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NPI Number | 1306260344
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Entity Type | Organization
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Legal Business Name | SHINE SPEECH THERAPY LLC
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 22 HIGH ST STE 101
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City | BRATTLEBORO
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State | VT
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Zip | 05301-2845
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Country | US
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Telephone | 802-258-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 22 HIGH ST STE 101
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City | BRATTLEBORO
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State | VT
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Zip | 05301-2845
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Country | US
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Telephone | 802-258-7115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH SHINE
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Credential |
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Telephone | 802-258-7115
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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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