Provider Demographics
NPI:1740986157
Name:NATURES EDGE THERAPY SERVICES
Entity type:Organization
Organization Name:NATURES EDGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:513-284-9539
Mailing Address - Street 1:1127 E SALTAIR BLF
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-7830
Mailing Address - Country:US
Mailing Address - Phone:513-284-9539
Mailing Address - Fax:
Practice Address - Street 1:1127 E SALTAIR BLF
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-7830
Practice Address - Country:US
Practice Address - Phone:513-284-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0238407Medicaid