Provider Demographics
NPI:1174708689
Name:STRIDES THERAPY CENTER
Entity type:Organization
Organization Name:STRIDES THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DECIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:641-780-8041
Mailing Address - Street 1:2397 OLD HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:IA
Mailing Address - Zip Code:50256-8534
Mailing Address - Country:US
Mailing Address - Phone:641-621-1122
Mailing Address - Fax:641-621-1177
Practice Address - Street 1:604 LIBERTY ST
Practice Address - Street 2:STE 229
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1775
Practice Address - Country:US
Practice Address - Phone:641-780-8041
Practice Address - Fax:641-621-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02356225100000X
IA01692225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty