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General NPI Number Information
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NPI Number | 1730531005
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Entity Type | Organization
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Legal Business Name | MOVING UP PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 625 E 5TH ST SUITE 104
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City | SHERIDAN
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State | WY
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Zip | 82801-3171
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Country | US
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Telephone | 307-672-5631
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Fax |
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Provider Business Mailing Address
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Address Line | 625 E 5TH ST SUITE 104
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City | SHERIDAN
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State | WY
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Zip | 82801-3171
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Country | US
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Telephone | 307-672-5631
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | JENNIFER W MCPHIE
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Credential | OTR/L
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Telephone | 307-672-5631
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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 | OTR 586
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License Number State | WY
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