Provider Demographics
NPI:1518717859
Name:INTENTIONAL THERAPY CARE LLC
Entity Type:Organization
Organization Name:INTENTIONAL THERAPY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DREWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-438-3826
Mailing Address - Street 1:725 W MAUMEE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1930
Mailing Address - Country:US
Mailing Address - Phone:419-438-3826
Mailing Address - Fax:
Practice Address - Street 1:725 W MAUMEE AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1930
Practice Address - Country:US
Practice Address - Phone:419-438-3826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty