Provider Demographics
NPI:1306891932
Name:THE THERAPY PLACE, L.L.C.
Entity type:Organization
Organization Name:THE THERAPY PLACE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:269-544-2901
Mailing Address - Street 1:626 MAPLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1032
Mailing Address - Country:US
Mailing Address - Phone:269-544-2901
Mailing Address - Fax:269-341-9919
Practice Address - Street 1:626 MAPLE HILL DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1032
Practice Address - Country:US
Practice Address - Phone:269-544-2901
Practice Address - Fax:269-341-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28080Medicare ID - Type Unspecified