Provider Demographics
NPI:1518356195
Name:EXCEPTIONAL PEDIATRIC THERAPY @ HOME, PLLC
Entity Type:Organization
Organization Name:EXCEPTIONAL PEDIATRIC THERAPY @ HOME, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NEDRA
Authorized Official - Middle Name:GENELLE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:832-487-9872
Mailing Address - Street 1:9610 LONG POINT RD
Mailing Address - Street 2:STE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4265
Mailing Address - Country:US
Mailing Address - Phone:832-487-9872
Mailing Address - Fax:832-487-9880
Practice Address - Street 1:9610 LONG POINT RD
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4265
Practice Address - Country:US
Practice Address - Phone:832-487-9872
Practice Address - Fax:832-487-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health