Provider Demographics
NPI:1689208480
Name:THE FUN IN FUNCTION LLC
Entity Type:Organization
Organization Name:THE FUN IN FUNCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRESSOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-463-0683
Mailing Address - Street 1:6142 SHALLOWFORD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7216
Mailing Address - Country:US
Mailing Address - Phone:423-463-0683
Mailing Address - Fax:423-250-1651
Practice Address - Street 1:6142 SHALLOWFORD RD STE 104
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7216
Practice Address - Country:US
Practice Address - Phone:423-463-0683
Practice Address - Fax:423-250-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ059922Medicaid