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General NPI Number Information
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NPI Number | 1154613495
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PATHWAYS INC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 17400 MONTEREY RD STE 2E
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City | MORGAN HILL
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State | CA
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Zip | 95037-7319
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Country | US
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Telephone | 408-778-6200
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Fax | 408-484-1096
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Provider Business Mailing Address
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Address Line | 17400 MONTEREY RD STE 2E
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City | MORGAN HILL
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State | CA
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Zip | 95037-7319
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Country | US
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Telephone | 408-778-6200
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Fax | 408-484-1096
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. ELIZABETH CLERK BELLIVEAU
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Credential | OTR/L
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Telephone | 408-778-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT4831
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License Number State | CA
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