MEDICARE: ASSOCAITES IN PEDIATRIC THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1801340070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCAITES IN PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	1900 MIDLAND TRL STE 1&2
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8141
Country	:	US
Telephone Number	:	502-633-1007
Fax Number	:	502-437-0624

Provider Business Practice Location Address
First Line	:	3703 STONE LAKES DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-5495
Country	:	US
Telephone Number	:	502-633-1007
Fax Number	:	502-437-0624

Authorized Official
Title or Position	:	CEO/SLP
Name	:	MRS. ANGELA RENEA SAGESER
Credential	:	SLP
Telephone Number	:	502-633-1007

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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