NPIMap

Organization Active NPI

Pediatric Therapy Center

  • Pediatric Occupational Therapist
  • Papillion, NE
National Provider Identifier
1396915427
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Legal business name
PEDIATRIC THERAPY CENTER
Practice address
10601 S 72ND St
Ste. 103
Papillion, NE 68046-3407
Phone
(402) 932-2782
Fax
(402) 932-2705
NPI assigned
Mar 4, 2008
Last updated
Jul 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

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

Authorized official

Name
Mrs. Candice S Mullendore, OTR/L
Title
Owner
Phone
(402) 932-2782

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X NU
Pediatric Occupational Therapist 225XP0200X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

10601 S 72ND St
Ste. 103
Papillion, NE 68046-3407

Mailing address

10601 S 72ND St
Ste. 103
Papillion, NE 68046-3407
Phone (402) 932-2782

National Provider Directory

National Provider Directory

Locations

10601 S 72nd St
Ste 103
Papillion, NE 68046
Phone (402) 932-2782

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435795200000",
    "number": "1396915427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10601 S 72ND ST",
            "address_2": "STE. 103",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680463407",
            "telephone_number": "402-932-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10601 S 72ND ST",
            "address_2": "STE. 103",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680463407",
            "telephone_number": "402-932-2782",
            "fax_number": "402-932-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2015-07-02",
        "status": "A",
        "authorized_official_last_name": "MULLENDORE",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-932-2782",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Papillion, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.