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General NPI Number Information
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NPI Number | 1427890789
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Entity Type | Organization
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Legal Business Name | FIRST CLASS PEDIATRICS PLLC
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 112 OAK CROSSING DR
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City | SHELBY
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State | NC
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Zip | 28152-1010
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Country | US
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Telephone | 704-476-9925
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Fax |
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Provider Business Mailing Address
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Address Line | 112 OAK CROSSING DR
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City | SHELBY
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State | NC
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Zip | 28152-1010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER /OCCUPATIONAL THERAPIST
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Name | JADA NICOLE LESLIE JOHNSON
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Credential |
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Telephone | 704-476-9925
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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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