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General NPI Number Information
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NPI Number | 1467151985
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Entity Type | Organization
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Legal Business Name | FUN HOUSE PEDIATRIC THERAPY SERVICES
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 138 MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-6249
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Country | US
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Telephone | 860-329-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FRANKIE LN
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City | TERRYVILLE
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State | CT
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Zip | 06786-7022
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Country | US
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Telephone | 860-329-2444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YADIRA VALDES
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Credential | MOT, OTR/L
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Telephone | 860-329-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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