Provider Demographics
NPI:1114633401
Name:GROW FEEDING THERAPY INC
Entity Type:Organization
Organization Name:GROW FEEDING THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT; OCCUPATIONAL THERAP
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGLIMSAMARNSUK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L,SWC
Authorized Official - Phone:661-383-0606
Mailing Address - Street 1:18723 VIA PRINCESSA
Mailing Address - Street 2:UNIT #735
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:922 N CROFT AVE
Practice Address - Street 2:APT 202
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:661-383-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty