Healthcare Provider Details

I. General information

NPI: 1740713833
Provider Name (Legal Business Name): ATHENA THERAPY HOLDING CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 E LIBERTY ST
GIRARD OH
44420-2316
US

IV. Provider business mailing address

4293 COLUMBIA RD
MEDINA OH
44256-7707
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-6550
  • Fax: 330-545-6877
Mailing address:
  • Phone: 330-410-3982
  • Fax: 330-451-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
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: TERESA BRADFORD
Title or Position: PRESIDENT
Credential: RN
Phone: 330-410-3982