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General NPI Number Information
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NPI Number | 1457591851
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Entity Type | Organization
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Legal Business Name | PEDIATRIC BUILDING BLOCKS
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 1276 GABRIEL CT
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City | SAN LEANDRO
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State | CA
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Zip | 94577-6821
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Country | US
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Telephone | 510-895-1214
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Fax | 510-895-1029
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Provider Business Mailing Address
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Address Line | 1276 GABRIEL CT
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City | SAN LEANDRO
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State | CA
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Zip | 94577-6821
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Country | US
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Telephone | 510-895-1214
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Fax | 510-895-1029
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | MARGARET A BLEDSOE
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Credential | OTRL
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Telephone | 510-895-1214
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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 | OT 1757
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License Number State | CA
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