Healthcare Provider Details

I. General information

NPI: 1063268035
Provider Name (Legal Business Name): THE THERAPY COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 HACKBERRY RD
BLOOMINGTON IL
61704-2776
US

IV. Provider business mailing address

PO BOX 1004
BLOOMINGTON IL
61702-1004
US

V. Phone/Fax

Practice location:
  • Phone: 309-846-0513
  • Fax:
Mailing address:
  • Phone: 309-846-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH NORWOOD
Title or Position: FOUNDER, OCCUPATIONAL THERAPIST
Credential: OTD
Phone: 309-846-0513