Kiki Logan

Individual provider Active NPI Early Intervention Provider Agency · Ellenboro, NC

NPI 1700327178 · NPPES record last updated Mar 17, 2017

Key facts

NPI
1700327178
Entity type
Individual (NPI type 1)
Primary specialty
Early Intervention Provider Agency 252Y00000X
Practice address
245 E Park Rd
Ellenboro, NC 28040-7621
Phone
(828) 305-3870
NPI assigned
Mar 17, 2017
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X Yes

Addresses

Primary practice location

245 E Park Rd
Ellenboro, NC 28040-7621

Mailing address

245 E Park Rd
Ellenboro, NC 28040-7621
Phone (828) 305-3870

Other providers in Ellenboro, NC

All providers in Ellenboro, NC · Early Intervention Provider Agency in North Carolina

Sources for this page

Verify at the official NPI Registry.