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General NPI Number Information
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NPI Number | 1750608022
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Entity Type | Organization
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Legal Business Name | MISSING PIECE THERAPY GROUP, LLC
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY PLZ
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City | YOUNGSTOWN
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State | OH
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Zip | 44555-0001
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Country | US
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Telephone | 215-630-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 406 ATWOOD CT
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-3054
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Country | US
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Telephone | 215-630-0123
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DENISE M KURELKO
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Credential |
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Telephone | 215-630-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric 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 | 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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