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General NPI Number Information
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NPI Number | 1992172605
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Entity Type | Organization
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Legal Business Name | ATHENA THERAPY HOLDING CO
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 260 NILES CORTLAND RD NE
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City | WARREN
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State | OH
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Zip | 44484-1938
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Country | US
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Telephone | 330-609-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 4293 COLUMBIA RD
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City | MEDINA
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State | OH
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Zip | 44256-7707
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Country | US
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Telephone | 330-410-3982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERESA BRADFORD
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Credential |
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Telephone | 330-410-3982
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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 | OT4846
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License Number State | OH
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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 | SP8620
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT009793
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License Number State | OH
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