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Organization
PEDIATRIC DEVELOPMENTAL THERAPY
Active
Organization
PEDIATRIC DEVELOPMENTAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HADEN PAYNE BOLIEK MSCCCSLP (PRESIDENT)
(910) 483-8331
Entity
Organization
Contact information
Practice address
1289 OLIVER ST, FAYETTEVILLE, NC 28304-4450
(910) 483-8331
(910) 483-8335
Mailing address
PO BOX 87294, FAYETTEVILLE, NC 28304-7294
(910) 483-8331
(910) 483-8335
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7210315
—
NC
Enumeration date
05/04/2006
Last updated
08/30/2016
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