Provider Demographics
NPI:1427402841
Name:PEDIASKILLS
Entity type:Organization
Organization Name:PEDIASKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL INTERVENTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:STRAND
Authorized Official - Suffix:
Authorized Official - Credentials:BS MED IECE
Authorized Official - Phone:502-905-8699
Mailing Address - Street 1:344 PERSIMMON WAY
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8715
Mailing Address - Country:US
Mailing Address - Phone:502-905-8699
Mailing Address - Fax:
Practice Address - Street 1:344 PERSIMMON WAY
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-8715
Practice Address - Country:US
Practice Address - Phone:502-905-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY233083280252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency