Provider Demographics
NPI:1326229576
Name:KAUFMAN THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:KAUFMAN THERAPY SERVICES, LLC
Other - Org Name:REHAB PROFESSIONALS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:803-530-2214
Mailing Address - Street 1:105 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8741
Mailing Address - Country:US
Mailing Address - Phone:803-530-2214
Mailing Address - Fax:803-788-4715
Practice Address - Street 1:105 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8741
Practice Address - Country:US
Practice Address - Phone:803-530-2214
Practice Address - Fax:803-788-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2864252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3803Medicaid