Provider Demographics
NPI:1205022373
Name:SWING FOR THE STARS PEDIATRIC THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:SWING FOR THE STARS PEDIATRIC THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:603-228-7827
Mailing Address - Street 1:2 PILLSBURY ST STE 404
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3523
Mailing Address - Country:US
Mailing Address - Phone:603-228-7827
Mailing Address - Fax:603-228-7828
Practice Address - Street 1:2 PILLSBURY ST STE 404
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3523
Practice Address - Country:US
Practice Address - Phone:603-228-7827
Practice Address - Fax:603-228-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3719225100000X, 2251P0200X
NH1712225X00000X, 225XP0200X
NH1126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty