# MITAN PEDIATRIC THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184704900
- **Authorized official:** ROBIN MITAN OT (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (618) 806-8461

## Contact information

- **Practice address:** 891 MEADOWVIEW LANE, COLUMBIA, IL 62236
- **Practice address phone:** (618) 806-8461
- **Mailing address:** 891 MEADOWVIEW LANE, COLUMBIA, IL 62236
- **Mailing address phone:** (618) 806-8461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 2000155595 | MO | — |
| 225X00000X | Occupational Therapist | — | IL | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 06732018 | BLUE CROSS BLUE SHIELD OF | — |
| 01 | — | 7058311 | AETNA | — |