Provider Demographics
NPI:1215782032
Name:I-PEDIA THERAPY CENTER, LLC
Entity type:Organization
Organization Name:I-PEDIA THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMAINE
Authorized Official - Middle Name:MA VERONICA
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:325-977-9327
Mailing Address - Street 1:1902 W NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9565
Mailing Address - Country:US
Mailing Address - Phone:325-977-9327
Mailing Address - Fax:
Practice Address - Street 1:2411 WEST LOOP
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9478
Practice Address - Country:US
Practice Address - Phone:325-977-9327
Practice Address - Fax:325-276-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty