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General NPI Number Information
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NPI Number | 1700399755
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Entity Type | Organization
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Legal Business Name | LEAP PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 2106 MONARDA WAY
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City | WAXHAW
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State | NC
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Zip | 28173-7072
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Country | US
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Telephone | 978-420-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 MONARDA WAY
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City | WAXHAW
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State | NC
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Zip | 28173-7072
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Country | US
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Telephone | 978-420-8850
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Fax |
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Authorized Official
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Title or Position | OWNER-DIRECTOR
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Name | MS. JUDY CLARE SPEICHER
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Credential | SLP
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Telephone | 978-420-8850
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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 | 10717
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License Number State | NC
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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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