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General NPI Number Information
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NPI Number | 1851871677
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Entity Type | Organization
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Legal Business Name | IMPACT THERAPY, LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 3450 W CENTRAL AVE STE 354
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City | TOLEDO
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State | OH
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Zip | 43606-1418
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Country | US
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Telephone | 419-407-5578
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Fax | 844-272-8238
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Provider Business Mailing Address
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Address Line | 3450 W CENTRAL AVE STE 354
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City | TOLEDO
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State | OH
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Zip | 43606-1418
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Country | US
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Telephone | 419-407-5578
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Fax | 844-272-8238
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KIM OATS
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Credential | LICDC-CS
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Telephone | 419-349-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 01-7629
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License Number State | OH
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