Provider Demographics
NPI:1336273143
Name:ONLINE THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:ONLINE THERAPY SERVICES INC.
Other - Org Name:MARIPOSA REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:719-846-4178
Mailing Address - Street 1:207 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2710
Mailing Address - Country:US
Mailing Address - Phone:719-846-4178
Mailing Address - Fax:719-846-4179
Practice Address - Street 1:207 E MAIN
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082
Practice Address - Country:US
Practice Address - Phone:719-846-4178
Practice Address - Fax:719-846-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06351239Medicaid