Provider Demographics
NPI:1912256827
Name:HOP SKIP AND A JUMP LLC
Entity type:Organization
Organization Name:HOP SKIP AND A JUMP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-570-2337
Mailing Address - Street 1:105 WINDSOR PATH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9617
Mailing Address - Country:US
Mailing Address - Phone:502-570-2337
Mailing Address - Fax:502-570-2338
Practice Address - Street 1:105 WINDSOR PATH
Practice Address - Street 2:SUITE 1
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9617
Practice Address - Country:US
Practice Address - Phone:502-570-2337
Practice Address - Fax:502-570-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
KY2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100236820Medicaid
KY000000800679OtherANTHEM
KY7100302990Medicaid
KYK071720Medicare PIN