MEDICARE: IMAGO CHILDREN'S THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1154210375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGO CHILDREN'S THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1553 BRANDYWINE DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-6802
Country	:	US
Telephone Number	:	302-668-5887
Fax Number	:

Provider Business Practice Location Address
First Line	:	1553 BRANDYWINE DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-6802
Country	:	US
Telephone Number	:	302-668-5887
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LEAD OCCUPATIONAL THERAPIST
Name	:	LINDSAY KIEHL GOOD MUDALEL
Credential	:	MS, OTR/L
Telephone Number	:	302-668-5887

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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