Thera Kids, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

R1597 Issued in KY

Legal business name

THERA KIDS, LLC

Practice address

77 Mize Branch Rd
Manchester, KY 40962-6632

Phone

(606) 599-2079

Fax

(606) 599-5437

NPI assigned

Oct 12, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carol Marcum, OTR/L

Title

President/Occupational Therapist

Phone

(606) 599-2079

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444608000000",
    "number": "1013388412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 MIZE BRANCH RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409626632",
            "telephone_number": "606-599-2079",
            "fax_number": "606-599-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MIZE BRANCH RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409626632",
            "telephone_number": "606-599-2079",
            "fax_number": "606-599-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERA KIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-12",
        "last_updated": "2015-10-12",
        "status": "A",
        "authorized_official_last_name": "MARCUM",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PRESIDENT/OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "606-599-2079",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "004379",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "R1597",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "1845",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Manchester, KY
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• Occupational Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.