MEDICARE: PELVIWORKS PEDIATRICS, 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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1912746041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELVIWORKS PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	14194 ESCONDIDA CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-0171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6704
Country	:	US
Telephone Number	:	260-466-7565
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	HOLLY GUENTHER
Credential	:	OTD, OTR/L
Telephone Number	:	260-466-7565

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	05/20/2024

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