Organization
PALMETTO EARLY INTERVENTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK GORDON SCHULTZ JR. MSP, CCC-SLP (ADMINISTRATOR)
(803) 586-5280
Entity
Organization
Contact information
Practice address
223 SILVERBROOK LN, LEXINGTON, SC 29073-6727
(803) 586-5280
(888) 801-0752
Mailing address
223 SILVERBROOK LN, LEXINGTON, SC 29073-6727
(803) 586-5280
(803) 708-1729
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4929
—
SC
05
—
SA0900
—
SC
Enumeration date
08/18/2008
Last updated
05/12/2010
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