Provider Demographics
NPI:1750593828
Name:THERAPY MADE FUN INC
Entity type:Organization
Organization Name:THERAPY MADE FUN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAGENA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:IMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:479-754-2107
Mailing Address - Street 1:PO BOX 1622
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-1622
Mailing Address - Country:US
Mailing Address - Phone:479-754-2107
Mailing Address - Fax:
Practice Address - Street 1:1000 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-2252
Practice Address - Country:US
Practice Address - Phone:479-754-6210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1512171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty