Provider Demographics
NPI:1902437841
Name:SPEECH & OCCUPATIONAL THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:SPEECH & OCCUPATIONAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:TEAGUE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:434-228-1812
Mailing Address - Street 1:PO BOX 10864
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5015
Mailing Address - Country:US
Mailing Address - Phone:434-799-7732
Mailing Address - Fax:866-468-5040
Practice Address - Street 1:159 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-799-7732
Practice Address - Fax:866-468-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty