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General NPI Number Information
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NPI Number | 1962796565
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Entity Type | Organization
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Legal Business Name | GIVING CHILDREN A CHANCE, LLC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 139 WINDING WOODS DR
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City | O FALLON
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State | MO
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Zip | 63366-3976
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Country | US
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Telephone | 314-406-5209
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Fax |
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Provider Business Mailing Address
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Address Line | 139 WINDING WOODS DR
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City | O FALLON
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State | MO
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Zip | 63366-3976
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Country | US
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Telephone | 314-406-5209
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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. TRISHA LEA TAYLOR
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Credential | MOT, OTR-L
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Telephone | 314-406-5209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 2004022422
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License Number State | MO
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