Provider Demographics
NPI:1043505472
Name:SUCCESS IN MOTION THERAPY LLC
Entity Type:Organization
Organization Name:SUCCESS IN MOTION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:612-250-5097
Mailing Address - Street 1:2637 27TH AVE S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1565
Mailing Address - Country:US
Mailing Address - Phone:612-250-5097
Mailing Address - Fax:612-823-0208
Practice Address - Street 1:2637 27TH AVE S
Practice Address - Street 2:SUITE 212
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1565
Practice Address - Country:US
Practice Address - Phone:612-250-5097
Practice Address - Fax:612-823-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty