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General NPI Number Information
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NPI Number | 1578792594
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Entity Type | Organization
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Legal Business Name | INTERACTIVE THERAPY INC
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Dates
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Enumeration Date | 07/12/2009
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Last Update Date | 07/12/2009
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Provider Practice Location Address
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Address Line | 220 N FORSYTH BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3616
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Country | US
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Telephone | 314-541-4283
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Fax | 314-725-2451
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Provider Business Mailing Address
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Address Line | 220 N FORSYTH BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3616
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Country | US
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Telephone | 314-541-4283
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Fax | 314-725-2451
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PAMELA KAY HASS
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Credential |
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Telephone | 314-541-4283
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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 | 00962
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License Number State | MO
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