=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811095599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPY FOR ME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7624 EXECUTIVE DR
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-944-0240
-----------------------------------------------------
Fax | 952-944-0241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19009 KINGSWOOD TER
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55345-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-474-0119
-----------------------------------------------------
Fax | 952-474-0119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | LUCY M. SEGESKY
-----------------------------------------------------
Credential | OTR/L, MED
-----------------------------------------------------
Telephone | 612-799-3771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 102516
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------