Healthcare Provider Details

I. General information

NPI: 1366358020
Provider Name (Legal Business Name): HARBOR PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10174 W FLORISSANT AVE
SAINT LOUIS MO
63136-2104
US

IV. Provider business mailing address

10174 W FLORISSANT AVE
SAINT LOUIS MO
63136-2104
US

V. Phone/Fax

Practice location:
  • Phone: 816-343-8169
  • Fax:
Mailing address:
  • Phone: 816-343-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
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: MOHAMED ELALEM
Title or Position: MANAGING MEMBER
Credential:
Phone: 816-343-8169