Provider Demographics
NPI:1225868649
Name:CUSTOM JOY LLC
Entity type:Organization
Organization Name:CUSTOM JOY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, DESIGN CONSULTANT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:CROSS
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-552-7387
Mailing Address - Street 1:8816 MANCHESTER RD
Mailing Address - Street 2:#293
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144
Mailing Address - Country:US
Mailing Address - Phone:314-632-6463
Mailing Address - Fax:
Practice Address - Street 1:16 LINDWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124
Practice Address - Country:US
Practice Address - Phone:314-632-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Single Specialty