Provider Demographics
NPI:1063125094
Name:READY SET GROW PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:READY SET GROW PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OT
Authorized Official - Prefix:
Authorized Official - First Name:SHALI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DENISON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:423-736-7369
Mailing Address - Street 1:13 PENDLETON PL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2169
Mailing Address - Country:US
Mailing Address - Phone:423-736-7369
Mailing Address - Fax:
Practice Address - Street 1:1241 VOLUNTEER PKWY STE 400
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4635
Practice Address - Country:US
Practice Address - Phone:910-818-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty