Healthcare Provider Details

I. General information

NPI: 1134575129
Provider Name (Legal Business Name): CHILDREN'S THERAPY ASSOCIATES OF THE BAY AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S LINDEN AVE SUITE 211
SOUTH SAN FRANCISCO CA
94080-6419
US

IV. Provider business mailing address

4046 26TH ST
SAN FRANCISCO CA
94131-1913
US

V. Phone/Fax

Practice location:
  • Phone: 415-606-9773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DIAMOND
Title or Position: PT, DIRECTOR
Credential:
Phone: 415-606-9773