Provider Demographics
NPI:1902092000
Name:MOD SOLUTION LLC
Entity Type:Organization
Organization Name:MOD SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMWAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:877-663-1919
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:605 NORTH HERSEY
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420
Mailing Address - Country:US
Mailing Address - Phone:877-663-1919
Mailing Address - Fax:785-738-2028
Practice Address - Street 1:605 NORTH HERSEY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420
Practice Address - Country:US
Practice Address - Phone:877-663-1919
Practice Address - Fax:785-738-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01970225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Single Specialty