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General NPI Number Information
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NPI Number | 1114750742
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Entity Type | Organization
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Legal Business Name | STACKED THERAPIES
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 410 TAHOE DR
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City | BURLINGTON
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State | WI
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Zip | 53105-9568
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Country | US
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Telephone | 262-207-4032
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | BURLINGTON
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State | WI
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Zip | 53105-0494
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Country | US
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Telephone | 262-207-4032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY LYNN CORREA
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Credential | OTD
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Telephone | 262-207-4031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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