MEDICARE: THE VILLAGE PEDIATRIC THERAPY 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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1295353324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	24723 N 115TH AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-9723
Country	:	US
Telephone Number	:	602-579-4703
Fax Number	:

Provider Business Practice Location Address
First Line	:	24723 N 115TH AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85373-9723
Country	:	US
Telephone Number	:	602-579-4703
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIDGET LEE THOMPSON
Credential	:	OTR
Telephone Number	:	602-579-4703

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	05/22/2024

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