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General NPI Number Information
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NPI Number | 1427379536
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Entity Type | Organization
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Legal Business Name | PREFERRED THERAPY OF GREATER CINCINNATI LLC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 1667 KELLYWOOD AVE
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City | CINCINNATI
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State | OH
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Zip | 45238-4011
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Country | US
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Telephone | 513-470-7051
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Fax | 513-471-3145
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Provider Business Mailing Address
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Address Line | 1667 KELLYWOOD AVE
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City | CINCINNATI
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State | OH
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Zip | 45238-4011
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Country | US
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Telephone | 513-470-7051
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Fax | 513-471-3145
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. JULIE NICOLE ROBERTS
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Credential |
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Telephone | 513-470-7051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | KY2515
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License Number State | KY
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