Healthcare Provider Details

I. General information

NPI: 1487713269
Provider Name (Legal Business Name): HAND IN HAND THERAPY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 E DUPONT RD
FORT WAYNE IN
46825-1668
US

IV. Provider business mailing address

2837 E DUPONT RD
FORT WAYNE IN
46825-1668
US

V. Phone/Fax

Practice location:
  • Phone: 260-497-0328
  • Fax: 260-497-0904
Mailing address:
  • Phone: 260-497-0328
  • Fax: 260-497-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number310002939A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006769A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003959A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002999A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002907A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003349A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002279A
License Number StateIN

VIII. Authorized Official

Name: MRS. KARI A MASON
Title or Position: OWNER PROVIDER
Credential: MA CCC SLP
Phone: 260-497-0328