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General NPI Number Information
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NPI Number | 1326639535
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Entity Type | Organization
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Legal Business Name | MAKING WAVES PEDIATRIC THERAPY CLINIC LLC
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2600 JAMES RD STE 200
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City | GRANBURY
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State | TX
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Zip | 76049-3122
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Country | US
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Telephone | 949-355-5291
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 JAMES RD STE 200
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City | GRANBURY
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State | TX
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Zip | 76049-3122
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Country | US
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Telephone | 817-910-8131
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Fax | 817-616-2713
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE MCCABE
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Credential | RN
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Telephone | 949-355-5291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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