Organization
PEDIATRIC DEVELOPMENTAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HADEN PAYNE BOLIEK MS CCC SLP (OWNER)
(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
225400000X
Rehabilitation Practitioner
Primary
—
NC
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301184
—
NC
Enumeration date
06/25/2007
Last updated
08/15/2013
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