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General NPI Number Information
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NPI Number | 1851392997
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Entity Type | Organization
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Legal Business Name | SOUTH METRO THERAPLAY, LLC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 314 MAIN ST E SUITE 3
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2448
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Country | US
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Telephone | 952-758-5775
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Fax | 952-758-5778
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Provider Business Mailing Address
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Address Line | 314 MAIN ST E SUITE 3
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2448
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Country | US
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Telephone | 952-758-5775
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Fax | 952-758-5778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ANDREA KAY MALECHA
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Credential | OTR/L
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Telephone | 952-758-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MN
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Taxonomy #2
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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 | MN
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