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General NPI Number Information
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NPI Number | 1730897851
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Entity Type | Organization
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Legal Business Name | BLUEBIRD SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 308 CATES ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4904
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Country | US
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Telephone | 865-214-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CATES ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4904
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Country | US
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Telephone | 865-214-7792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NICOLE VOTTA TOMICZEK
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Credential | M.A., CCC-SLP
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Telephone | 865-214-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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