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General NPI Number Information
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NPI Number | 1740713833
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Entity Type | Organization
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Legal Business Name | ATHENA THERAPY HOLDING CO
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 798 E LIBERTY ST
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City | GIRARD
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State | OH
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Zip | 44420-2316
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Country | US
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Telephone | 330-545-6550
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Fax | 330-545-6877
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Provider Business Mailing Address
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Address Line | 4293 COLUMBIA RD
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City | MEDINA
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State | OH
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Zip | 44256-7707
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Country | US
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Telephone | 330-410-3982
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Fax | 330-451-5711
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERESA BRADFORD
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Credential | RN
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Telephone | 330-410-3982
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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