Healthcare Provider Details

I. General information

NPI: 1780858621
Provider Name (Legal Business Name): THE TALCOTT CENTER FOR CHILD DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 08/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MAIN STREET SUITE A
FARMINGTON CT
06032
US

IV. Provider business mailing address

230 FARMINGTON AVE
FARMINGTON CT
06032-1916
US

V. Phone/Fax

Practice location:
  • Phone: 806-674-1824
  • Fax: 860-674-1836
Mailing address:
  • Phone: 860-674-1824
  • Fax: 860-674-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: PETER DAVIDSON
Title or Position: CEO
Credential:
Phone: 860-674-1824