Basic Information
| Provider Information | |||||||||
| NPI: | 1669766341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALMETTO EARLY BEGINNINGS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 RIDGE RUN TRL | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290638667 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 355 RIDGE RUN TRL | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290638667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032712364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 05/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOYKIN | ||||||||
| AuthorizedOfficialFirstName: | GENEA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8032712364 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 3951 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.