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General NPI Number Information
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NPI Number | 1942286372
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPLAY SPEECH SERVICES, INC.
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Dates
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Enumeration Date | 12/18/2005
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Last Update Date | 12/09/2007
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Provider Practice Location Address
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Address Line | 3403 LINDEN BERRY LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-1300
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Country | US
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Telephone | 704-258-1724
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Fax | 704-598-3024
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Provider Business Mailing Address
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Address Line | PO BOX 480462
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City | CHARLOTTE
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State | NC
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Zip | 28269-5320
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Country | US
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Telephone | 704-258-1724
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Fax | 704-598-3024
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. WENDY YOSHINO TEAL
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Credential | CCC-SLP
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Telephone | 704-258-1724
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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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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | NC
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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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 | NC
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