Provider Demographics
NPI:1508250184
Name:SIMPLE STROKES THERAPY CONSULTANTS, PA
Entity Type:Organization
Organization Name:SIMPLE STROKES THERAPY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:662-349-8787
Mailing Address - Street 1:83 AIRWAYS PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5885
Mailing Address - Country:US
Mailing Address - Phone:662-349-8787
Mailing Address - Fax:662-349-8757
Practice Address - Street 1:12311 ASHLEY DR STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2950
Practice Address - Country:US
Practice Address - Phone:228-357-5253
Practice Address - Fax:662-349-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2662225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty