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General NPI Number Information
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NPI Number | 1699120832
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Entity Type | Organization
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Legal Business Name | HAND TO HAND PEDIATRIC THERAPY
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 4941 BENCHMARK CENTRE DR SUITE 300
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City | SWANSEA
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State | IL
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Zip | 62226-2038
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Country | US
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Telephone | 618-628-3540
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Fax | 618-628-3249
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Provider Business Mailing Address
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Address Line | 4941 BENCHMARK CENTRE DR SUITE 300
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City | SWANSEA
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State | IL
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Zip | 62226-2038
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Country | US
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Telephone | 618-628-3540
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Fax | 618-628-3249
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA ANNE MILLER
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Credential | O.T.
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Telephone | 618-407-1396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 056004907
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License Number State | IL
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