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General NPI Number Information
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NPI Number | 1578005849
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Entity Type | Organization
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Legal Business Name | STIMULATE YOUR CHILD DEVELOPMENTAL THERAPY PLLC
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 1646 RUSTIC ARCH WAY
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3628
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Country | US
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Telephone | 704-975-2840
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Fax | 704-998-8907
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Provider Business Mailing Address
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Address Line | 1646 RUSTIC ARCH WAY
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3628
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Country | US
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Telephone | 704-975-2840
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Fax | 704-998-8907
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GEORGIANA C LUKE-HENRY
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Credential | OTR/L
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Telephone | 704-975-2840
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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 | 7509
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License Number State | NC
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