Healthcare Provider Details

I. General information

NPI: 1124402623
Provider Name (Legal Business Name): CHILDREN'S THERAPY CENTER, CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 CROWN BLVD SUITE 100A
SAN JOSE CA
95120-2903
US

IV. Provider business mailing address

6501 CROWN BLVD SUITE 100A
SAN JOSE CA
95120-2903
US

V. Phone/Fax

Practice location:
  • Phone: 408-601-0993
  • Fax:
Mailing address:
  • Phone: 408-601-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11778
License Number StateCA

VIII. Authorized Official

Name: BRITTNEY WEINERTH
Title or Position: PRESIDENT
Credential: MS, OTR/L
Phone: 408-601-0993