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General NPI Number Information
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NPI Number | 1386203297
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Entity Type | Organization
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Legal Business Name | CHILDREN ARE REALLY ACTIVE THERAPY,LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 4808 MARKET SQUARE LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4826
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Country | US
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Telephone | 804-405-6316
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Fax |
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Provider Business Mailing Address
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Address Line | 4808 MARKET SQUARE LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4826
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Country | US
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Telephone | 804-405-6316
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR/OT
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Name | SALLY WALKER-CRUDEN
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Credential | OTR/L
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Telephone | 804-405-6316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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