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General NPI Number Information
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NPI Number | 1659188670
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Entity Type | Organization
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Legal Business Name | WELLVERSED PEDIATRIC THERAPY
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 9560 LEGACY DR STE 270
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City | FRISCO
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State | TX
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Zip | 75033-6753
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Country | US
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Telephone | 469-604-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 9560 LEGACY DR STE 270
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City | FRISCO
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State | TX
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Zip | 75033-6753
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Country | US
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Telephone | 469-604-7090
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHYLANDA T TOTTRESS
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Credential |
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Telephone | 817-938-9975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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