Provider Demographics
NPI:1346630035
Name:INLAND EMPIRE THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:INLAND EMPIRE THERAPY ASSOCIATES LLC
Other - Org Name:EMPIRE PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAILE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOHSENIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:509-701-7651
Mailing Address - Street 1:501 S BERNARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2511
Mailing Address - Country:US
Mailing Address - Phone:509-701-7651
Mailing Address - Fax:509-279-2636
Practice Address - Street 1:501 S BERNARD ST STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2511
Practice Address - Country:US
Practice Address - Phone:509-701-7651
Practice Address - Fax:509-279-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAOT60223038225X00000X
WAOT60269905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty