Healthcare Provider Details

I. General information

NPI: 1316207673
Provider Name (Legal Business Name): CHILD DEVELOPMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367-2514
US

IV. Provider business mailing address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367-2514
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-4559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOAN MALTESE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-888-4559