Healthcare Provider Details

I. General information

NPI: 1184050833
Provider Name (Legal Business Name): CHILDREN'S THERAPY AND LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 BLACK ROCK TPKE STE 201
FAIRFIELD CT
06825-3237
US

IV. Provider business mailing address

2228 BLACK ROCK TPKE STE 201
FAIRFIELD CT
06825-3237
US

V. Phone/Fax

Practice location:
  • Phone: 203-908-4433
  • Fax:
Mailing address:
  • Phone: 203-908-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number002439C
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002439
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number002439
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number002439
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number000828
License Number StateCT

VIII. Authorized Official

Name: MRS. ALLISON M MCFARLAND
Title or Position: BILLER
Credential:
Phone: 860-647-8852