Healthcare Provider Details

I. General information

NPI: 1083380828
Provider Name (Legal Business Name): TREEHOUSE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOLLYWOOD BLVD SW STE 7
FORT WALTON BEACH FL
32548-4893
US

IV. Provider business mailing address

24 HOLLYWOOD BLVD SW STE 7
FORT WALTON BEACH FL
32548-4893
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-7411
  • Fax: 850-226-7496
Mailing address:
  • Phone: 850-226-7411
  • Fax: 850-226-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TEHRA MCCLELLAN
Title or Position: OWNER
Credential:
Phone: 850-226-7411