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NPI Code Detail

MEDICARE: HEATON PEDIATRIC THERAPY INC.

MEDICARE: HEATON PEDIATRIC THERAPY INC.
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
1224Z00000XOccupational Therapy Assistant3187SC
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist
4225X00000XOccupational Therapist

General Provider Information

NPI Number : 1700255056
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEATON PEDIATRIC THERAPY INC.
Provider Business Mailing Address
First Line : PO BOX 1312
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-1054
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 204 SHADY PINES CT
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-9785
Country : US
Telephone Number : 864-399-2674
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : TRAVIS HEATON
Credential :
Telephone Number : 864-399-2674
Provider Enumeration Date : 09/16/2015
Last Update Date : 09/25/2016

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Directions to “HEATON PEDIATRIC THERAPY INC. ” Practice Location

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