MEDICARE: PROJECT CHILLD LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225XP0200X	Pediatric Occupational Therapist
3	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OG0033	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1366598310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT CHILLD LLC

Provider Business Mailing Address
First Line	:	500 CUMMINGS CTR
Second Line	:	SUITE 3850
City	:	BEVERLY
State	:	MA
Zip	:	01915-6142
Country	:	US
Telephone Number	:	978-232-0332
Fax Number	:	978-232-1103

Provider Business Practice Location Address
First Line	:	500 CUMMINGS CTR
Second Line	:	SUITE 3850
City	:	BEVERLY
State	:	MA
Zip	:	01915-6142
Country	:	US
Telephone Number	:	978-232-0332
Fax Number	:	978-232-1103

Authorized Official
Title or Position	:	OWNER-DIRECTOR
Name	:	MS. KATHLEEN ANN CARLEY
Credential	:	M.S. O.T.R. L.
Telephone Number	:	978-232-0332

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/24/2008

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Directions to “PROJECT CHILLD LLC ” Practice Location

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