Provider Demographics
NPI:1659415735
Name:STEPPING STONES PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:STEPPING STONES PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEETWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:919-751-9120
Mailing Address - Street 1:111 TREY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9086
Mailing Address - Country:US
Mailing Address - Phone:919-751-9120
Mailing Address - Fax:919-751-9170
Practice Address - Street 1:111 TREY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9086
Practice Address - Country:US
Practice Address - Phone:919-751-9120
Practice Address - Fax:919-751-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841347788OtherINDIVIDUAL NPI