MEDICARE: SOUTH METRO THERAPLAY, 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	235Z00000X	Speech-Language Pathologist		MN
2	225X00000X	Occupational Therapist		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	685S4SO	OTHER	MN	BCBS OT PROVIDER #
2	101451	OTHER	MN	HEALTH PARTNERS PROVIDER#
3	7137545	OTHER	MN	AETNA PROVIDER#
4	4600753	OTHER	MN	MEDICA PROVIDER#
5	685S8SO	OTHER	MN	BCBS SPEECH PROVIDER #
6	1040435	OTHER	MN	PREFERRED ONE PROVIDER#

General Provider Information

NPI Number	:	1851392997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH METRO THERAPLAY, LLC

Provider Business Mailing Address
First Line	:	314 MAIN ST E
Second Line	:	SUITE 3
City	:	NEW PRAGUE
State	:	MN
Zip	:	56071-2448
Country	:	US
Telephone Number	:	952-758-5775
Fax Number	:	952-758-5778

Provider Business Practice Location Address
First Line	:	314 MAIN ST E
Second Line	:	SUITE 3
City	:	NEW PRAGUE
State	:	MN
Zip	:	56071-2448
Country	:	US
Telephone Number	:	952-758-5775
Fax Number	:	952-758-5778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ANDREA KAY MALECHA
Credential	:	OTR/L
Telephone Number	:	952-758-5775

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/11/2025

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Directions to “SOUTH METRO THERAPLAY, LLC ” Practice Location

Language	Start Address	Practice Location

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