Provider Demographics
NPI:1306562467
Name:IMAGINATION STATION THERAPY, PLLC
Entity type:Organization
Organization Name:IMAGINATION STATION THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:HUGHES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:304-550-7295
Mailing Address - Street 1:91 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-5599
Mailing Address - Country:US
Mailing Address - Phone:304-550-7295
Mailing Address - Fax:800-686-9093
Practice Address - Street 1:91 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-5599
Practice Address - Country:US
Practice Address - Phone:304-550-7295
Practice Address - Fax:800-686-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty