Provider Demographics
NPI:1700318219
Name:EMPIRE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:EMPIRE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAILE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSENIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:509-701-7651
Mailing Address - Street 1:2527 E 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4909
Mailing Address - Country:US
Mailing Address - Phone:509-701-7651
Mailing Address - Fax:509-279-2636
Practice Address - Street 1:2527 E 27TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4909
Practice Address - Country:US
Practice Address - Phone:509-701-7651
Practice Address - Fax:509-279-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60269905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty