=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700302908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEED 320 REHABILITATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 E FERNHURST DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-644-8863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E FERNHURST DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-644-8863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MS. CHERYL PAYNE
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 240-644-8863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 105178
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------