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General NPI Number Information
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NPI Number | 1558203620
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Entity Type | Organization
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Legal Business Name | LSA PEDIATRIC THERAPY
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 1502 GOODMAN RD W
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City | HORN LAKE
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State | MS
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Zip | 38637-1407
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Country | US
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Telephone | 901-674-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 14132 STRAFFORD LN
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8462
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Country | US
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Telephone | 901-674-2877
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHEON NESHELL MOORE
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Credential |
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Telephone | 901-674-2877
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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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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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