Provider Demographics
NPI:1609431360
Name:OVER THE MOON THERAPY, LLC
Entity Type:Organization
Organization Name:OVER THE MOON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:KATE DAWSON
Authorized Official - Last Name:AREINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:520-271-6771
Mailing Address - Street 1:1215 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6406
Mailing Address - Country:US
Mailing Address - Phone:520-271-6771
Mailing Address - Fax:
Practice Address - Street 1:1215 E 14TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-6406
Practice Address - Country:US
Practice Address - Phone:520-271-6771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ397656Medicaid