Provider Demographics
NPI:1518605286
Name:COLA PEDIATRIC THERAPY COLLECTIVE
Entity Type:Organization
Organization Name:COLA PEDIATRIC THERAPY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKORZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:803-391-2603
Mailing Address - Street 1:141 HICKORY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8876
Mailing Address - Country:US
Mailing Address - Phone:803-232-8349
Mailing Address - Fax:
Practice Address - Street 1:141 HICKORY MEADOW RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8876
Practice Address - Country:US
Practice Address - Phone:803-232-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty