Provider Demographics
NPI:1619002227
Name:FUN 2 BE ME DEVELOPMENTAL THERAPY LLC
Entity Type:Organization
Organization Name:FUN 2 BE ME DEVELOPMENTAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:440-567-5220
Mailing Address - Street 1:3355 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9631
Mailing Address - Country:US
Mailing Address - Phone:440-567-5220
Mailing Address - Fax:
Practice Address - Street 1:3355 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9631
Practice Address - Country:US
Practice Address - Phone:440-567-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.002088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty