MEDICARE: RADIANT MOMENTS PEDIATRIC THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1194486365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT MOMENTS PEDIATRIC THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1009 BRADBURN DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6904
Country	:	US
Telephone Number	:	919-228-8094
Fax Number	:	984-287-7200

Provider Business Practice Location Address
First Line	:	1009 BRADBURN DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6904
Country	:	US
Telephone Number	:	919-228-8094
Fax Number	:	984-287-7200

Authorized Official
Title or Position	:	OWNER
Name	:	CAITLIN RICH BURKE
Credential	:
Telephone Number	:	919-228-8094

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	06/08/2026

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