| Organization Name: | SEASIDE SPEECH THERAPY, LLC |
| NPI Number: | 1033546825 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ATMAR BRADLEY (SPEECH-LANGUAGE PATHOLOGIST/OWNER) |
| Mailing Address: | 280 Bampfield Dr Mount Pleasant |
| State: | SC US |
| Postal Code: | 294642501 |
| Phone Number: | 8438849667 |
| Fax Number: | 8436541102 |
| NPI Enumeration Date: | 10/11/2013 |
| NPI Last Update Date: | 10/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |