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General NPI Number Information
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NPI Number | 1801773973
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Entity Type | Organization
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Legal Business Name | HOME GROWN PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 23429 N HIGHWAY 99W
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City | NEWBERG
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State | OR
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Zip | 97132-6865
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Country | US
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Telephone | 541-643-8320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | DUNDEE
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State | OR
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Zip | 97115-0001
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Country | US
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Telephone | 541-643-8320
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Fax |
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | STEPHANIE VANCE
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Credential | OTR/L
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Telephone | 541-643-8320
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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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