Provider Demographics
NPI:1790328359
Name:INTEGRATED AUTISM THERAPIES
Entity Type:Organization
Organization Name:INTEGRATED AUTISM THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-913-9963
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-0127
Mailing Address - Country:US
Mailing Address - Phone:707-255-3300
Mailing Address - Fax:707-255-3527
Practice Address - Street 1:5984 S SUSQUEHANNA
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5527
Practice Address - Country:US
Practice Address - Phone:801-243-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED AUTISM THERAPIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty