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General NPI Number Information
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NPI Number | 1912314691
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Entity Type | Organization
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Legal Business Name | KIDS IN PROCESS DEVELOPMENTAL THERAPY
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 6347 W JUDY AVE
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City | VISALIA
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State | CA
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Zip | 93277-0814
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Country | US
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Telephone | 559-737-3790
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Fax | 559-735-0874
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Provider Business Mailing Address
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Address Line | 6347 W JUDY AVE
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City | VISALIA
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State | CA
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Zip | 93277-0814
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Country | US
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Telephone | 559-737-3790
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Fax | 559-735-0874
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Authorized Official
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Title or Position | PEDIATRIC OCCUPATIONAL THERAPIST
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Name | SHIRLYN R MALLEY
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Credential | M.A, OTR L
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Telephone | 559-737-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6265
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License Number State | CA
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