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General NPI Number Information
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NPI Number | 1457057549
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Entity Type | Organization
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Legal Business Name | TADPOLE PEDIATRIC THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 1309 MORNINGSIDE DR
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City | CHARLOTTE
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State | NC
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Zip | 28205-5326
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Country | US
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Telephone | 704-302-7861
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 MORNINGSIDE DR
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City | CHARLOTTE
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State | NC
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Zip | 28205-5326
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Country | US
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Telephone | 704-302-7861
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | KELLY WEYNAND
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Credential | MS, OTR/L
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Telephone | 704-302-7861
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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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