Provider Demographics
NPI:1275312332
Name:MOUNTAIN KIND THERAPY SERVICES
Entity Type:Organization
Organization Name:MOUNTAIN KIND THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:931-319-0003
Mailing Address - Street 1:915 60TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRUETLI LAAGER
Mailing Address - State:TN
Mailing Address - Zip Code:37339-5017
Mailing Address - Country:US
Mailing Address - Phone:931-319-0003
Mailing Address - Fax:
Practice Address - Street 1:30989 STATE ROUTE 108
Practice Address - Street 2:
Practice Address - City:GRUETLI LAAGER
Practice Address - State:TN
Practice Address - Zip Code:37339-5113
Practice Address - Country:US
Practice Address - Phone:931-319-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty