1811591837 NPI number — ANCHOR & ARROW THERAPY AND WELLNESS FOR KIDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811591837 NPI number — ANCHOR & ARROW THERAPY AND WELLNESS FOR KIDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHOR & ARROW THERAPY AND WELLNESS FOR KIDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811591837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 BECK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON TOWNSHIP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45458-4520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-689-9296
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 KENTSHIRE DR STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45440-2989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-365-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LEY
Authorized Official First Name:
GINA
Authorized Official Middle Name:
DEANN
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
937-689-9296

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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