Provider Demographics
NPI:1225205586
Name:EXCEPTIONAL CHILD THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:EXCEPTIONAL CHILD THERAPY SERVICES, PLLC
Other - Org Name:THERAPLAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-608-7827
Mailing Address - Street 1:510 WILLOW STONE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5568
Mailing Address - Country:US
Mailing Address - Phone:502-608-7827
Mailing Address - Fax:502-384-1429
Practice Address - Street 1:510 WILLOW STONE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5568
Practice Address - Country:US
Practice Address - Phone:502-608-7827
Practice Address - Fax:502-384-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1227252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency