Organization
ADVANTAGE SPEECH THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM PETERS (OFFICE MANAGER)
(919) 847-6773
Entity
Organization
Contact information
Practice address
8402 SIX FORKS RD STE 101, RALEIGH, NC 27615-3071
(919) 847-6773
(919) 847-6827
Mailing address
8402 SIX FORKS RD STE 101, RALEIGH, NC 27615-3071
(919) 847-6773
(919) 847-6827
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7411308
—
NC
Enumeration date
11/21/2006
Last updated
06/03/2013
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