Provider Demographics
NPI:1437357456
Name:GASTON THERAPY, LLC
Entity Type:Organization
Organization Name:GASTON THERAPY, LLC
Other - Org Name:CENTER FOR PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:CLEMENTS
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:423-486-4060
Mailing Address - Street 1:112 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6802
Mailing Address - Country:US
Mailing Address - Phone:423-468-4060
Mailing Address - Fax:423-468-4069
Practice Address - Street 1:112 JORDAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6802
Practice Address - Country:US
Practice Address - Phone:423-468-4060
Practice Address - Fax:423-468-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2774103TC0700X
1041C0700X
TN14222251P0200X
TN26552251P0200X
TN377225XP0200X
TN2796225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty