MEDICARE: SENIOR THERAPY RESOURCES, INC.

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	225X00000X	Occupational Therapist	056008120	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4532934	OTHER	IL	BLUE CROSS BLUE SHIELD OF ILLINOIS
2	1437459401	OTHER		SOLE PROPRIETOR NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750720579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR THERAPY RESOURCES, INC.

Provider Business Mailing Address
First Line	:	2921 WATERLEAF RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-3176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 WATERLEAF RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-3176
Country	:	US
Telephone Number	:	719-322-5923
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA CEINSKI
Credential	:
Telephone Number	:	719-322-5923

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	03/09/2022

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1437459401 — LISA CEINSKI MS, OTR/L
Practice Location Address:

2921 WATERLEAF RD
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1689161598 — STACY ANN MESSERSMITH FNP
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1912871518 — CHANTELLE J KAPP LMFT
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