Provider Demographics
NPI:1972802304
Name:ACE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:ACE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SLIZEWSKI
Authorized Official - Last Name:MEAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:719-439-8035
Mailing Address - Street 1:720 N BEAR PAW LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3215
Mailing Address - Country:US
Mailing Address - Phone:719-439-8035
Mailing Address - Fax:719-694-2732
Practice Address - Street 1:720 N BEAR PAW LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3215
Practice Address - Country:US
Practice Address - Phone:719-439-8035
Practice Address - Fax:719-694-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2336225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty