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General NPI Number Information
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NPI Number | 1205022373
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Entity Type | Organization
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Legal Business Name | SWING FOR THE STARS PEDIATRIC THERAPY CENTER, LLC
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 2 PILLSBURY ST STE 404
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City | CONCORD
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State | NH
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Zip | 03301-3523
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Country | US
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Telephone | 603-228-7827
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Fax | 603-228-7828
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Provider Business Mailing Address
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Address Line | 2 PILLSBURY ST STE 404
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City | CONCORD
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State | NH
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Zip | 03301-3523
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Country | US
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Telephone | 603-228-7827
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Fax | 603-228-7828
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JODELLE L HEATH
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Credential | MS OTR/L
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Telephone | 603-228-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1126
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 1712
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3719
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 3719
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License Number State | NH
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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 | 1712
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License Number State | NH
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