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General NPI Number Information
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NPI Number | 1558609412
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Entity Type | Organization
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Legal Business Name | SMITH PEDIATRIC THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 01/27/2013
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Last Update Date | 01/27/2013
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Provider Practice Location Address
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Address Line | 342 CROSS ST
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City | CHARLESTON
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State | SC
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Zip | 29407-6905
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Country | US
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Telephone | 843-763-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 342 CROSS ST
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City | CHARLESTON
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State | SC
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Zip | 29407-6905
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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 | SPEECH PATHOLOGIST
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Name | JENNIFER G SMITH
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Credential | MRS, CCC-SLP
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Telephone | 843-763-8699
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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 | 3961
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License Number State | SC
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