Provider Demographics
NPI:1861638223
Name:THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:715-693-7178
Mailing Address - Street 1:415 ORBITING DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1762
Mailing Address - Country:US
Mailing Address - Phone:715-693-7178
Mailing Address - Fax:715-693-7178
Practice Address - Street 1:415 ORBITING DR
Practice Address - Street 2:SUITE B
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1762
Practice Address - Country:US
Practice Address - Phone:715-693-7178
Practice Address - Fax:715-693-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1700-026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41012200Medicaid