Provider Demographics
NPI:1194258467
Name:BLUE STARS THERAPY, LLC
Entity type:Organization
Organization Name:BLUE STARS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HORMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:314-650-9288
Mailing Address - Street 1:1101 EDWARD TER APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1520
Mailing Address - Country:US
Mailing Address - Phone:314-650-9288
Mailing Address - Fax:
Practice Address - Street 1:1101 EDWARD TER APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1520
Practice Address - Country:US
Practice Address - Phone:314-650-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027319252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency