Healthcare Provider Details

I. General information

NPI: 1912035742
Provider Name (Legal Business Name): MEALTIME CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N TUCSON BLVD STE 6
TUCSON AZ
85716-3404
US

IV. Provider business mailing address

PO BOX 40094
TUCSON AZ
85717-0094
US

V. Phone/Fax

Practice location:
  • Phone: 520-829-9635
  • Fax: 520-829-9636
Mailing address:
  • Phone: 520-829-9635
  • Fax: 520-829-9636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY EDWARDS
Title or Position: MEMBER
Credential: OTR
Phone: 520-241-7194