Provider Demographics
NPI: | 1730314204 |
---|---|
Name: | MID-AMERICA THERAPY SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | MID-AMERICA THERAPY SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MARLA |
Authorized Official - Middle Name: | JEAN |
Authorized Official - Last Name: | SHYKEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR/L |
Authorized Official - Phone: | 314-434-5410 |
Mailing Address - Street 1: | 14360 S OUTER 40 |
Mailing Address - Street 2: | |
Mailing Address - City: | TOWN AND COUNTRY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63017-5710 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-434-5410 |
Mailing Address - Fax: | 314-431-5640 |
Practice Address - Street 1: | 14360 S OUTER 40 |
Practice Address - Street 2: | |
Practice Address - City: | TOWN AND COUNTRY |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63017-5710 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-434-5410 |
Practice Address - Fax: | 314-431-5640 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-27 |
Last Update Date: | 2009-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Single Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Single Specialty |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Single Specialty |