Provider Demographics
NPI:1386407153
Name:FIRM FOUNDATIONS PEDIATRIC THERAPY
Entity type:Organization
Organization Name:FIRM FOUNDATIONS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:803-460-4655
Mailing Address - Street 1:1271 COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148-7008
Mailing Address - Country:US
Mailing Address - Phone:803-460-4655
Mailing Address - Fax:
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-6904
Practice Address - Country:US
Practice Address - Phone:803-460-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty