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NPI Code Detail

MEDICARE: CHILDREN'S THERAPY CLINIC INC

MEDICARE: CHILDREN'S THERAPY CLINIC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251V00000XVoluntary or Charitable Agency

General Provider Information

NPI Number : 1336477835
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S THERAPY CLINIC INC
Provider Business Mailing Address
First Line : PO BOX 2707
Second Line :
City : CHARLESTON
State : WV
Zip : 25330-2707
Country : US
Telephone Number : 304-342-9515
Fax Number : 304-342-9414
Provider Business Practice Location Address
First Line : 113 LAKEVIEW DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25313-1467
Country : US
Telephone Number : 304-342-9515
Fax Number : 304-342-9414
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : VALICIA LEARY
Credential :
Telephone Number : 304-342-9515
Provider Enumeration Date : 11/23/2009
Last Update Date : 11/23/2009

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Directions to “CHILDREN'S THERAPY CLINIC INC ” Practice Location

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