Provider Demographics
NPI:1134382096
Name:INDEPENDENCE THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:INDEPENDENCE THERAPY ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-952-4560
Mailing Address - Street 1:25 INDIAN ROCK RD STE 11
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1691
Mailing Address - Country:US
Mailing Address - Phone:603-952-4560
Mailing Address - Fax:603-952-4561
Practice Address - Street 1:25 INDIAN ROCK RD STE 11
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1691
Practice Address - Country:US
Practice Address - Phone:603-952-4560
Practice Address - Fax:603-952-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081126Medicaid