Provider Demographics
NPI:1851392997
Name:SOUTH METRO THERAPLAY, LLC
Entity type:Organization
Organization Name:SOUTH METRO THERAPLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MALECHA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:952-758-5775
Mailing Address - Street 1:314 MAIN ST E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2448
Mailing Address - Country:US
Mailing Address - Phone:952-758-5775
Mailing Address - Fax:952-758-5778
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-758-5775
Practice Address - Fax:952-758-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN685S4SOOtherBCBS OT PROVIDER #
MN101451OtherHEALTH PARTNERS PROVIDER#
MN7137545OtherAETNA PROVIDER#
MN4600753OtherMEDICA PROVIDER#
MN685S8SOOtherBCBS SPEECH PROVIDER #
MN1040435OtherPREFERRED ONE PROVIDER#