Provider Demographics
NPI:1053193615
Name:ALTAIR EDUCATIONAL AND THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:ALTAIR EDUCATIONAL AND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANALYN
Authorized Official - Middle Name:MAGPANTAY
Authorized Official - Last Name:JOENS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, EDD, OTR/L
Authorized Official - Phone:240-429-1806
Mailing Address - Street 1:18484 W SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4918
Mailing Address - Country:US
Mailing Address - Phone:623-419-1998
Mailing Address - Fax:623-321-6387
Practice Address - Street 1:18484 W SUNRISE DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4918
Practice Address - Country:US
Practice Address - Phone:623-419-1998
Practice Address - Fax:623-321-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty