Healthcare Provider Details

I. General information

NPI: 1851392997
Provider Name (Legal Business Name): SOUTH METRO THERAPLAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST E SUITE 3
NEW PRAGUE MN
56071-2448
US

IV. Provider business mailing address

314 MAIN ST E SUITE 3
NEW PRAGUE MN
56071-2448
US

V. Phone/Fax

Practice location:
  • Phone: 952-758-5775
  • Fax: 952-758-5778
Mailing address:
  • Phone: 952-758-5775
  • Fax: 952-758-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMN

VIII. Authorized Official

Name: MISS ANDREA KAY MALECHA
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 952-758-5775