Provider Demographics
NPI:1043966492
Name:DAISY PEDIATRIC SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:DAISY PEDIATRIC SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIE'RRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOFTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:757-632-2456
Mailing Address - Street 1:5705 LYNNHAVEN PKWY STE 104 PMB 1227
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8533
Mailing Address - Country:US
Mailing Address - Phone:757-632-2456
Mailing Address - Fax:
Practice Address - Street 1:10 MAST COURT
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-997-2537
Practice Address - Fax:757-432-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty