Provider Demographics
NPI:1235681909
Name:BEANSTALK THERAPIES LLC
Entity Type:Organization
Organization Name:BEANSTALK THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:773-544-9928
Mailing Address - Street 1:211 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2130
Mailing Address - Country:US
Mailing Address - Phone:773-544-9928
Mailing Address - Fax:815-531-0043
Practice Address - Street 1:211 E PARK CIR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2130
Practice Address - Country:US
Practice Address - Phone:773-544-9928
Practice Address - Fax:815-531-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty