Provider Demographics
NPI:1912384876
Name:HAND SPEECH THERAPY
Entity Type:Organization
Organization Name:HAND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-260-4516
Mailing Address - Street 1:564 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-3604
Mailing Address - Country:US
Mailing Address - Phone:919-548-2130
Mailing Address - Fax:336-923-5848
Practice Address - Street 1:564 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-3604
Practice Address - Country:US
Practice Address - Phone:919-548-2130
Practice Address - Fax:336-923-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952544462OtherNPI NUMBER