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General NPI Number Information
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NPI Number | 1407166192
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Entity Type | Organization
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Legal Business Name | CHILDREN'S THERAPY INNOVATIONS INC.
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2012 IRONWOOD CIR STE 230
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City | SOUTH BEND
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State | IN
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Zip | 46635-1889
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Country | US
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Telephone | 574-387-4049
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Fax | 574-387-4062
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Provider Business Mailing Address
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Address Line | 2012 IRONWOOD CIR STE 230
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City | SOUTH BEND
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State | IN
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Zip | 46635-1889
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Country | US
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Telephone | 574-387-4049
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Fax | 574-387-4062
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LYDIA B OTIATO
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Credential | OTR
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Telephone | 574-387-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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