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Organization

DANDELION PEDIATRIC THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ASHLEY NICOLE BUCK MS, OTR/L (SOLE MEMBER)
(601) 826-2609
Entity
Organization

Contact information

Practice address
125 STILLHOUSE CREEK DR, MADISON, MS 39110-6943
(601) 826-2609
Mailing address
PO BOX 415, MADISON, MS 39130-0415
(601) 826-2609

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
2251P0200X
Pediatric Physical Therapist
225200000X
Physical Therapy Assistant
225X00000X
Occupational Therapist
225XP0200X
Pediatric Occupational Therapist
Primary
2355S0801X
Speech-Language Assistant
235Z00000X
Speech-Language Pathologist

Other

Enumeration date
09/09/2021
Last updated
09/09/2021
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