Healthcare Provider Details

I. General information

NPI: 1063741940
Provider Name (Legal Business Name): MILESTONES CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 S ESCONDIDO BLVD STE A
ESCONDIDO CA
92025-6573
US

IV. Provider business mailing address

1785 S ESCONDIDO BLVD STE A
ESCONDIDO CA
92025-6573
US

V. Phone/Fax

Practice location:
  • Phone: 760-740-0055
  • Fax:
Mailing address:
  • Phone: 760-740-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY TENNANT
Title or Position: OWNER
Credential:
Phone: 760-740-0055