Provider Demographics
NPI:1215128426
Name:INNOVATIVE PEDIATRIC PARTNERS
Entity type:Organization
Organization Name:INNOVATIVE PEDIATRIC PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:PARKES
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:412-491-1654
Mailing Address - Street 1:906 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2681
Mailing Address - Country:US
Mailing Address - Phone:412-491-1654
Mailing Address - Fax:412-257-3341
Practice Address - Street 1:906 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-2681
Practice Address - Country:US
Practice Address - Phone:412-491-1654
Practice Address - Fax:412-257-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006913L251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services