Provider Demographics
NPI:1740366186
Name:SWEETHOME MILESTONES THERAPY SERVICES,P.C.
Entity type:Organization
Organization Name:SWEETHOME MILESTONES THERAPY SERVICES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MATEBEJANA
Authorized Official - Last Name:MASHALA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:574-293-9907
Mailing Address - Street 1:56836 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-5838
Mailing Address - Country:US
Mailing Address - Phone:574-523-1418
Mailing Address - Fax:574-293-9908
Practice Address - Street 1:56836 MEADOWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5838
Practice Address - Country:US
Practice Address - Phone:574-523-1418
Practice Address - Fax:574-293-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002483A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty