Healthcare Provider Details

I. General information

NPI: 1700491271
Provider Name (Legal Business Name): HEARTLAND PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 2ND ST
LINDSBORG KS
67456-1805
US

IV. Provider business mailing address

425 N 2ND ST
LINDSBORG KS
67456-1805
US

V. Phone/Fax

Practice location:
  • Phone: 785-546-0665
  • Fax: 866-473-0308
Mailing address:
  • Phone: 785-546-0665
  • Fax: 866-473-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY ANN MALM
Title or Position: SPEECH THERAPIST
Credential: MA, CCC-SLP
Phone: 785-546-0665