MEDICARE: MOUNTAIN THERAPY & EDUCATION SERVICES, 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

General Provider Information

NPI Number	:	1780374298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN THERAPY & EDUCATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	127 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1414
Country	:	US
Telephone Number	:	570-435-7004
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MCKAYLA BODINE
Credential	:
Telephone Number	:	570-404-3272

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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Directions to “MOUNTAIN THERAPY & EDUCATION SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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