Provider Demographics
NPI:1255005203
Name:LIVE, LEARN, GROW - PEDIATRIC THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:LIVE, LEARN, GROW - PEDIATRIC THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:662-820-8732
Mailing Address - Street 1:906 TETBURY PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9274
Mailing Address - Country:US
Mailing Address - Phone:662-820-8732
Mailing Address - Fax:601-202-9606
Practice Address - Street 1:906 TETBURY PL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9274
Practice Address - Country:US
Practice Address - Phone:662-820-8732
Practice Address - Fax:601-202-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty