Provider Demographics
NPI:1659324556
Name:PEDIATRIC THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BHANU
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAGHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:937-885-7120
Mailing Address - Street 1:9130 INDIAN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9598
Mailing Address - Country:US
Mailing Address - Phone:937-885-7120
Mailing Address - Fax:937-885-7120
Practice Address - Street 1:9130 INDIAN SPRINGS CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-9598
Practice Address - Country:US
Practice Address - Phone:937-885-7120
Practice Address - Fax:937-885-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002338225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty