Healthcare Provider Details

I. General information

NPI: 1518585231
Provider Name (Legal Business Name): THERAFUN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N GREGG RD
NIXA MO
65714-9037
US

IV. Provider business mailing address

435 N GREGG RD
NIXA MO
65714-9037
US

V. Phone/Fax

Practice location:
  • Phone: 417-459-6441
  • Fax:
Mailing address:
  • Phone: 417-459-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BREWER
Title or Position: OWNER OTR/L
Credential:
Phone: 417-459-6441