Provider Demographics
NPI: | 1952994659 |
---|---|
Name: | WELL-NURTURED DEVELOPMENT |
Entity Type: | Organization |
Organization Name: | WELL-NURTURED DEVELOPMENT |
Other - Org Name: | WELL-NURTURED DEVELOPMENT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/OCCUPATIONAL THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | VANESKO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MOT, OTR-L, CIMI |
Authorized Official - Phone: | 570-336-0309 |
Mailing Address - Street 1: | PO BOX 241 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18612-0241 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 570-336-0309 |
Mailing Address - Fax: | 272-207-2774 |
Practice Address - Street 1: | 311 WYOMING AVE |
Practice Address - Street 2: | |
Practice Address - City: | WYOMING |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18644-1620 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-336-0309 |
Practice Address - Fax: | 272-207-2774 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-02-15 |
Last Update Date: | 2024-03-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |