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General NPI Number Information
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NPI Number | 1518390616
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Entity Type | Organization
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Legal Business Name | BLAST OFF CHILDREN'S THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 9520 PADGETT ST SUITE 104
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City | SAN DIEGO
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State | CA
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Zip | 92126-4445
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Country | US
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Telephone | 858-866-8133
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Fax | 858-999-2002
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Provider Business Mailing Address
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Address Line | 9520 PADGETT ST SUITE 104
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City | SAN DIEGO
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State | CA
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Zip | 92126-4445
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Country | US
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Telephone | 858-866-8133
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Fax | 858-999-2002
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MRS. LUANN H. LOWER
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Credential | MA, CCC-SLP
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Telephone | 858-866-8133
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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 | 13795
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License Number State | CA
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