Provider Demographics
NPI:1346815727
Name:CRADLE TO TABLE PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:CRADLE TO TABLE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KNOWSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-CLP
Authorized Official - Phone:434-414-7886
Mailing Address - Street 1:1359 SCOTTS BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936-2700
Mailing Address - Country:US
Mailing Address - Phone:434-414-7886
Mailing Address - Fax:
Practice Address - Street 1:1359 SCOTTS BOTTOM RD
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-2700
Practice Address - Country:US
Practice Address - Phone:434-414-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty