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General NPI Number Information
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NPI Number | 1972878825
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Entity Type | Organization
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Legal Business Name | WIGGLY KIDLETS
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 601 TRENTON RD STE D169
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City | MCALLEN
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State | TX
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Zip | 78504-2107
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Country | US
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Telephone | 956-371-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 601 TRENTON RD STE D169
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City | MCALLEN
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State | TX
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Zip | 78504-2107
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Country | US
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Telephone | 956-371-0817
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Fax |
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MRS. DAFFNEY VEALS OBARE
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Credential | SLPA
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Telephone | 956-371-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 33708
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License Number State | TX
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