| Pediatric Developmental Therapy | |
|
1289 Oliver St Fayetteville NC 28304-4450 | |
| (910) 483-8331 | |
| (910) 483-8335 |
| Full Name | Pediatric Developmental Therapy |
|---|---|
| Speciality | Rehabilitation Practitioner |
| Location | 1289 Oliver St, Fayetteville, North Carolina |
| Authorized Official Name and Position | Haden Payne Boliek (OWNER) |
| Authorized Official Contact | 9104838331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Developmental Therapy Po Box 87294 Fayetteville NC 28304-7294 Ph: (910) 483-8331 | Pediatric Developmental Therapy 1289 Oliver St Fayetteville NC 28304-4450 Ph: (910) 483-8331 |
| NPI Number | 1710183991 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710183991 | NPI | - | NPPES |
| 8301184 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 225400000X | Rehabilitation Practitioner | (North Carolina) | Primary |
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