Provider Demographics
NPI:1043063779
Name:PEDIATRICS IN THE PINES OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:PEDIATRICS IN THE PINES OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERPAIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHEY
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:623-693-4064
Mailing Address - Street 1:242 WHIPPLE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1789
Mailing Address - Country:US
Mailing Address - Phone:623-693-4064
Mailing Address - Fax:
Practice Address - Street 1:242 WHIPPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1789
Practice Address - Country:US
Practice Address - Phone:623-693-4064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty