Provider Demographics
NPI:1831362540
Name:PEDIATRIC THERAPY CENTER
Entity type:Organization
Organization Name:PEDIATRIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-331-9960
Mailing Address - Street 1:8050 SOQUEL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3981
Mailing Address - Country:US
Mailing Address - Phone:831-684-1804
Mailing Address - Fax:
Practice Address - Street 1:8050 SOQUEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3981
Practice Address - Country:US
Practice Address - Phone:831-684-1804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9816225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty