Provider Demographics
NPI:1629800578
Name:WONDER SPROUTS OT
Entity type:Organization
Organization Name:WONDER SPROUTS OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-310-1777
Mailing Address - Street 1:27492 BENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2504
Mailing Address - Country:US
Mailing Address - Phone:216-310-7777
Mailing Address - Fax:
Practice Address - Street 1:27492 BENWOOD CIR
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2504
Practice Address - Country:US
Practice Address - Phone:216-310-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant