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General NPI Number Information
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NPI Number | 1548978117
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Entity Type | Organization
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Legal Business Name | NURTURE PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 928 S MERRIFIELD AVE
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City | MISHAWAKA
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State | IN
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Zip | 46544-2807
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Country | US
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Telephone | 574-807-1456
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Fax | 574-807-9598
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Provider Business Mailing Address
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Address Line | 60610 FIR RD
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City | MISHAWAKA
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State | IN
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Zip | 46544-9216
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Country | US
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Telephone | 574-807-1456
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Fax | 574-807-9598
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Authorized Official
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Title or Position | OWNER
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Name | ALLISON ANNE PASCARELLA
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Credential | MA, CCC-SLP
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Telephone | 574-807-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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