MEDICARE: PEDIATRIC THERAPY CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1396915427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY CENTER

Provider Business Mailing Address
First Line	:	10601 S 72ND ST
Second Line	:	STE. 103
City	:	PAPILLION
State	:	NE
Zip	:	68046-3407
Country	:	US
Telephone Number	:	402-932-2782
Fax Number	:

Provider Business Practice Location Address
First Line	:	10601 S 72ND ST
Second Line	:	STE. 103
City	:	PAPILLION
State	:	NE
Zip	:	68046-3407
Country	:	US
Telephone Number	:	402-932-2782
Fax Number	:	402-932-2705

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CANDICE S MULLENDORE
Credential	:	OTR/L
Telephone Number	:	402-932-2782

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	07/02/2015

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Practice Location Address:

10601 S 72ND ST
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1518107093 — KRISTAN L PILAKOWSKI OTD, OTR/L
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Practice Location Address:

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Directions to “PEDIATRIC THERAPY CENTER ” Practice Location

Language	Start Address	Practice Location

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