=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740563329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALK & PLAY PEDIATRIC THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 LIECK CV
-----------------------------------------------------
City | CIBOLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78108-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-204-9371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 LIECK CV
-----------------------------------------------------
City | CIBOLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78108-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-204-9371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NANCY CHAGOYA
-----------------------------------------------------
Credential | SLP ASSISTANT
-----------------------------------------------------
Telephone | 210-204-9371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 34055
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------