Healthcare Provider Details

I. General information

NPI: 1528658432
Provider Name (Legal Business Name): PEDIATRIC THERAPY SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 3RD AVE
JASPER IN
47546-3602
US

IV. Provider business mailing address

675 3RD AVE
JASPER IN
47546-3602
US

V. Phone/Fax

Practice location:
  • Phone: 812-351-1490
  • Fax: 812-301-1329
Mailing address:
  • Phone: 812-351-1490
  • Fax: 812-301-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SCHILLING
Title or Position: BUSINESS MANAGER
Credential:
Phone: 812-351-1490