Provider Demographics
NPI:1083157143
Name:CHILDREN'S TL
Entity Type:Organization
Organization Name:CHILDREN'S TL
Other - Org Name:GEAUX PLAY PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BOENIG
Authorized Official - Last Name:D'AQUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-245-5170
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-1593
Mailing Address - Country:US
Mailing Address - Phone:225-245-5170
Mailing Address - Fax:225-308-3223
Practice Address - Street 1:5637 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:ST. FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-245-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LAZ12040225X00000X
LA4527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty