Basic Information
| Provider Information | |||||||||
| NPI: | 1346687332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPLACE LEARNING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4121 SHELBYVILLE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402073205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1502893138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4121 SHELBYVILLE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402073205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028931380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | COX-WOODALL | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5024945732 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 2251P0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.