MEDICARE: THERAPY SUCCESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP4043	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629328562	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629328562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY SUCCESS, LLC

Provider Business Mailing Address
First Line	:	5120 FOGGY RIVER LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-6261
Country	:	US
Telephone Number	:	901-596-2747
Fax Number	:	901-207-7189

Provider Business Practice Location Address
First Line	:	5120 FOGGY RIVER LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-6261
Country	:	US
Telephone Number	:	901-596-2747
Fax Number	:	901-207-7189

Authorized Official
Title or Position	:	REGISTERED AGENT/THERAPIST
Name	:	MS. ASHLEY R FOWLER
Credential	:	MCD, CCC-SLP
Telephone Number	:	901-596-2747

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	01/19/2016

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Directions to “THERAPY SUCCESS, LLC ” Practice Location

Language	Start Address	Practice Location

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