Healthcare Provider Details

I. General information

NPI: 1679334023
Provider Name (Legal Business Name): GROW PEDIATRIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HIGHWAY 131
WELLINGTON MO
64097-7119
US

IV. Provider business mailing address

30882 HIGHWAY NN
BLACKBURN MO
65321-2007
US

V. Phone/Fax

Practice location:
  • Phone: 660-202-7107
  • Fax:
Mailing address:
  • Phone: 660-202-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEVIN E GRAF
Title or Position: DIRECTOR
Credential: OTR/L
Phone: 660-202-7107