Organization
NUTRIO PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA SHINGLETON CCC-SLP (OWNER)
(561) 985-1455
Entity
Organization
Contact information
Practice address
405 FAIRDALE DR, SIMPSONVILLE, SC 29681-4450
(561) 985-1455
Mailing address
405 FAIRDALE DR, SIMPSONVILLE, SC 29681-4450
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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