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General NPI Number Information
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NPI Number | 1215487376
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Entity Type | Organization
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Legal Business Name | MILEMARKERS THERAPY
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 5601 HIGHWAY 95 N STE 308C5601
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-8536
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Country | US
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Telephone | 928-854-5439
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Fax | 928-854-5440
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Provider Business Mailing Address
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Address Line | 5601 HIGHWAY 95 N STE 308C
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-8546
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Country | US
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Telephone | 928-854-5439
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Fax | 928-854-5440
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | MRS. COLLEEN MCSHEA
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Credential | SLP
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Telephone | 928-854-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP4317
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License Number State | AZ
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