Provider Demographics
NPI:1487265732
Name:TUMBLEWEEDS PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:TUMBLEWEEDS PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MOT
Authorized Official - Phone:512-507-1102
Mailing Address - Street 1:528 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4408
Mailing Address - Country:US
Mailing Address - Phone:512-507-1102
Mailing Address - Fax:
Practice Address - Street 1:528 22ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4408
Practice Address - Country:US
Practice Address - Phone:541-525-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty