Provider Demographics
NPI:1609581099
Name:CAROLINA SPEECH AND NEURO REHAB, PLLC
Entity Type:Organization
Organization Name:CAROLINA SPEECH AND NEURO REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:828-776-8120
Mailing Address - Street 1:20 OLD SHARON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-7790
Mailing Address - Country:US
Mailing Address - Phone:828-776-8120
Mailing Address - Fax:828-579-2415
Practice Address - Street 1:2130 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-8233
Practice Address - Country:US
Practice Address - Phone:828-214-7899
Practice Address - Fax:828-579-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech