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General NPI Number Information
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NPI Number | 1528687472
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Entity Type | Organization
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Legal Business Name | EDUTHERAPY CONNECTION LLC
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 3518 GRENEDINE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28306
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Country | US
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Telephone | 910-977-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 GRENEDINE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-5610
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Country | US
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Telephone | 910-977-3706
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA T MONTALVO
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Credential |
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Telephone | 910-977-3706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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