Provider Demographics
NPI:1679334023
Name:GROW PEDIATRIC THERAPY SERVICES
Entity type:Organization
Organization Name:GROW PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:660-202-7107
Mailing Address - Street 1:30882 HIGHWAY NN
Mailing Address - Street 2:
Mailing Address - City:BLACKBURN
Mailing Address - State:MO
Mailing Address - Zip Code:65321-2007
Mailing Address - Country:US
Mailing Address - Phone:660-202-7107
Mailing Address - Fax:
Practice Address - Street 1:800 HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:64097-7119
Practice Address - Country:US
Practice Address - Phone:660-202-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty