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Organization
SOUTHERN OAKS THERAPY SERVICES LLC
Active
Organization
SOUTHERN OAKS THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY F WALL MA, CCC-SLP (OWNER/SPEECH LANGUAGE PATHOLOGIST)
(803) 943-6401
Entity
Organization
Contact information
Practice address
1460 POCOTALIGO RD, FAIRFAX, SC 29827-6826
(803) 943-6401
Mailing address
1460 POCOTALIGO RD, FAIRFAX, SC 29827-6826
(803) 943-6401
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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