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General NPI Number Information
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NPI Number | 1912637810
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY ON THE GO LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 2483 HERITAGE VLG STE 16314
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City | SNELLVILLE
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State | GA
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Zip | 30078-6140
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Country | US
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Telephone | 770-799-8116
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Fax |
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Provider Business Mailing Address
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Address Line | 2483 HERITAGE VLG STE 16314
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City | SNELLVILLE
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State | GA
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Zip | 30078-6140
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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 | OWNER
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Name | KATELYNN RICKARD
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Credential | M.ED., CCC-SLP
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Telephone | 229-457-0337
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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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