Healthcare Provider Details

I. General information

NPI: 1629373600
Provider Name (Legal Business Name): THERAPY 4 KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 NORWOOD DR
SAINT CHARLES MO
63303-3318
US

IV. Provider business mailing address

7055 MEXICO RD UNIT 1601
SAINT PETERS MO
63376-2344
US

V. Phone/Fax

Practice location:
  • Phone: 636-866-1341
  • Fax:
Mailing address:
  • Phone: 636-866-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA WILSON
Title or Position: CFO
Credential:
Phone: 636-866-1341