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General NPI Number Information
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NPI Number | 1801040746
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL THERAPY CENTER, INC.
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 845 4TH AVE SUITE 302A
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City | HUNTINGTON
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State | WV
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Zip | 25701-1428
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Country | US
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Telephone | 304-523-1164
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Fax | 304-522-2474
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Provider Business Mailing Address
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Address Line | 845 4TH AVE SUITE 302A
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City | HUNTINGTON
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State | WV
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Zip | 25701-1428
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Country | US
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Telephone | 304-523-1164
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Fax | 304-522-2474
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LESLIE C. COMER-PORTER
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Credential | MA,CCC-SLP
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Telephone | 304-523-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | SLP1168
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License Number State | WV
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