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General NPI Number Information
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NPI Number | 1902024912
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY & ACTIVITY CENTER
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2606 BRANDI LANE
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City | CORINTH
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State | TX
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Zip | 76208
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Country | US
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Telephone | 940-497-3003
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Fax | 940-497-9153
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Provider Business Mailing Address
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Address Line | 1406 N. CORINTH ST SUITE 405
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City | CORINTH
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State | TX
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Zip | 76208
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Country | US
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Telephone | 940-497-3003
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Fax | 940-497-9153
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Authorized Official
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Title or Position | OWNER
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Name | CINDY MCKENNA
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Credential | OTR
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Telephone | 940-497-3003
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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 | 103499
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License Number State | TX
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