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General NPI Number Information
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NPI Number | 1386407153
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Entity Type | Organization
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Legal Business Name | FIRM FOUNDATIONS PEDIATRIC THERAPY
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 116 MAIN ST
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City | SUMMERTON
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State | SC
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Zip | 29148-6904
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Country | US
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Telephone | 803-460-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 1271 COTTAGE DR
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City | SUMMERTON
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State | SC
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Zip | 29148-7008
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Country | US
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Telephone | 803-460-4655
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. JESSICA HALL YOUNT
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Credential | OTR/L
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Telephone | 803-460-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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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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Taxonomy #3
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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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