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General NPI Number Information
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NPI Number | 1821480344
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Entity Type | Organization
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Legal Business Name | PROCARE THERAPY
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 123 N EISENHOWER DR
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City | JUNCTION CITY
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State | KS
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Zip | 66441-3313
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Country | US
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Telephone | 785-717-9340
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Fax |
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Provider Business Mailing Address
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Address Line | 303 PORTER DR
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City | INDIANOLA
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State | MS
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Zip | 38751-3717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SLPA
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Name | KANOUSHA BURTON-MARTIN
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Credential |
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Telephone | 662-303-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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