Organization
ONLINE PEDIATRIC THERAPY
Active
Organization
ONLINE PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERI L ALLEN OTR/L (PARTNER)
(269) 207-6501
Entity
Organization
Contact information
Practice address
16725 E C AVE, AUGUSTA, MI 49012-9332
(269) 207-6501
Mailing address
16725 E C AVE, AUGUSTA, MI 49012-9332
(269) 207-6501
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501000917
MI
225X00000X
Occupational Therapist
Primary
5201000071
MI
235Z00000X
Speech-Language Pathologist
CCC# 12120774
—
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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