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General NPI Number Information
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NPI Number | 1942599089
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Entity Type | Organization
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Legal Business Name | CAPITAL CITY THERAPY GROUP, LLC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 100 OLD CHEROKEE RD SUITE F, BOX 172
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City | LEXINGTON
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State | SC
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Zip | 29072-9316
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Country | US
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Telephone | 803-467-8596
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Fax | 803-356-0468
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Provider Business Mailing Address
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Address Line | 100 OLD CHEROKEE RD SUITE F, BOX 172
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City | LEXINGTON
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State | SC
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Zip | 29072-9316
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Country | US
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Telephone | 803-467-8596
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Fax | 803-356-0468
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTINE SPEEGLE
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Credential | OT
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Telephone | 803804791758
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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 | 3537
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2606
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License Number State | SC
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