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General NPI Number Information
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NPI Number | 1275312332
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Entity Type | Organization
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Legal Business Name | MOUNTAIN KIND THERAPY SERVICES
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 30989 STATE ROUTE 108
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City | GRUETLI LAAGER
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State | TN
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Zip | 37339-5113
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Country | US
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Telephone | 931-319-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 915 60TH AVE S
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City | GRUETLI LAAGER
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State | TN
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Zip | 37339-5017
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Country | US
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Telephone | 931-319-0003
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Fax |
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Authorized Official
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Title or Position | OWNER; OTR/L
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Name | MORGAN FARRIS
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Credential | OTD, OTR/L
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Telephone | 931-319-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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