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General NPI Number Information
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NPI Number | 1619002227
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Entity Type | Organization
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Legal Business Name | FUN 2 BE ME DEVELOPMENTAL THERAPY LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3355 MEDINA RD
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City | MEDINA
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State | OH
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Zip | 44256-9631
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Country | US
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Telephone | 440-567-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 MEDINA RD
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City | MEDINA
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State | OH
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Zip | 44256-9631
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Country | US
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Telephone | 440-567-5220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA L BLAKE
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Credential | OTRL
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Telephone | 440-567-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT.002088
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License Number State | OH
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