Healthcare Provider Details

I. General information

NPI: 1811203680
Provider Name (Legal Business Name): PUTTING TOGETHER PUZZLE PIECES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 GATEPOST LN
OAK HILL VA
20171-2246
US

IV. Provider business mailing address

3014 GATEPOST LN
OAK HILL VA
20171-2246
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-1754
  • Fax:
Mailing address:
  • Phone: 703-391-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1-10-6920
License Number StateVA

VIII. Authorized Official

Name: MS. ROBIN ELIZABETH MOYHER
Title or Position: OWNDER
Credential: M.ED; BCBA
Phone: 703-391-1754