Provider Demographics
NPI:1942434220
Name:PROGRESSIVE OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:PROGRESSIVE OT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OT
Authorized Official - Prefix:MS
Authorized Official - First Name:LATRENA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:614-284-4223
Mailing Address - Street 1:5020 REED RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2581
Mailing Address - Country:US
Mailing Address - Phone:614-284-4223
Mailing Address - Fax:
Practice Address - Street 1:5020 REED RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2581
Practice Address - Country:US
Practice Address - Phone:614-284-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicare PIN