Provider Demographics
NPI:1093136285
Name:SUNSHINE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:POPE
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:256-658-3180
Mailing Address - Street 1:2521 WOODHURST DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-7900
Mailing Address - Country:US
Mailing Address - Phone:256-658-3180
Mailing Address - Fax:256-883-9550
Practice Address - Street 1:2521 WOODHURST DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-7900
Practice Address - Country:US
Practice Address - Phone:256-658-3180
Practice Address - Fax:256-883-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-15
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1273225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty