MEDICARE: PEDIATRIC THERAPY UNLIMITED INC

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	0330	MO

General Provider Information

NPI Number	:	1497896070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY UNLIMITED INC

Provider Business Mailing Address
First Line	:	PO BOX 4276
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-4276
Country	:	US
Telephone Number	:	573-270-1692
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 N BERKLEY ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1202
Country	:	US
Telephone Number	:	573-270-1692
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. TERESA JEAN COBB
Credential	:	OTRL
Telephone Number	:	573-270-1692

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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