Provider Demographics
NPI:1801773973
Name:HOME GROWN PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:HOME GROWN PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:541-643-8320
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-0001
Mailing Address - Country:US
Mailing Address - Phone:541-643-8320
Mailing Address - Fax:
Practice Address - Street 1:23429 N HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6865
Practice Address - Country:US
Practice Address - Phone:541-643-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty