Provider Demographics
NPI:1457426918
Name:CHILDREN'S THERAPY SERVICES
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:O'NEILL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:662-279-2523
Mailing Address - Street 1:164B COUNTY ROAD 363
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-7057
Mailing Address - Country:US
Mailing Address - Phone:662-279-2523
Mailing Address - Fax:
Practice Address - Street 1:164B COUNTY ROAD 363
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-7057
Practice Address - Country:US
Practice Address - Phone:662-279-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1721225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty