Healthcare Provider Details

I. General information

NPI: 1306248380
Provider Name (Legal Business Name): CAPTIAL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 INDEPENDENCE BLVD APT A
LANCASTER OH
43130-1272
US

IV. Provider business mailing address

1923 INDEPENDENCE BLVD APT A
LANCASTER OH
43130-1272
US

V. Phone/Fax

Practice location:
  • Phone: 740-412-7923
  • Fax:
Mailing address:
  • Phone: 740-412-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberOH3205097
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberOH3205097
License Number StateOH

VIII. Authorized Official

Name: MRS. KAITLIN JENSEN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA
Phone: 614-570-1143