Provider Demographics
NPI:1831594118
Name:THERAPEUTIC EDGE
Entity type:Organization
Organization Name:THERAPEUTIC EDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:419-775-6697
Mailing Address - Street 1:3284 ATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1410
Mailing Address - Country:US
Mailing Address - Phone:419-775-6697
Mailing Address - Fax:
Practice Address - Street 1:3284 ATLIN AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1410
Practice Address - Country:US
Practice Address - Phone:419-775-6697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04429251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health