Provider Demographics
NPI:1871271247
Name:HOMETOWN PEDIATRIC THERAPY
Entity type:Organization
Organization Name:HOMETOWN PEDIATRIC THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CUSANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-702-4252
Mailing Address - Street 1:5900 TAFTON CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3740
Mailing Address - Country:US
Mailing Address - Phone:919-702-4252
Mailing Address - Fax:
Practice Address - Street 1:5900 TAFTON CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3740
Practice Address - Country:US
Practice Address - Phone:919-702-4252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty