Provider Demographics
NPI:1508481466
Name:FORWARD FUNCTION THERAPY LLC
Entity Type:Organization
Organization Name:FORWARD FUNCTION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:TOBIAS
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:631-275-8288
Mailing Address - Street 1:5010 ELENORE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1300
Mailing Address - Country:US
Mailing Address - Phone:631-275-8288
Mailing Address - Fax:631-201-3377
Practice Address - Street 1:5010 ELENORE AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-1300
Practice Address - Country:US
Practice Address - Phone:631-275-8288
Practice Address - Fax:631-201-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty