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General NPI Number Information
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NPI Number | 1942098132
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Entity Type | Organization
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Legal Business Name | WONDERLAND PEDIATRIC THERAPY
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 10720 SIKES PL STE 120
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City | CHARLOTTE
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State | NC
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Zip | 28277-8142
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Country | US
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Telephone | 980-469-8109
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Fax | 704-973-9219
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Provider Business Mailing Address
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Address Line | 146 MARRON DR
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-4510
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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, OT ASSISTANT
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Name | JENNIFER MARIE FITZGERALD
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Credential | BA, COTA/L
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Telephone | 732-691-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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