Healthcare Provider Details

I. General information

NPI: 1366598310
Provider Name (Legal Business Name): PROJECT CHILLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CUMMINGS CTR SUITE 3850
BEVERLY MA
01915-6142
US

IV. Provider business mailing address

500 CUMMINGS CTR SUITE 3850
BEVERLY MA
01915-6142
US

V. Phone/Fax

Practice location:
  • Phone: 978-232-0332
  • Fax: 978-232-1103
Mailing address:
  • Phone: 978-232-0332
  • Fax: 978-232-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN ANN CARLEY
Title or Position: OWNER-DIRECTOR
Credential: M.S. O.T.R. L.
Phone: 978-232-0332