Provider Demographics
NPI:1144989187
Name:SPRINGTIDE CHILD DEVELOPMENT, INC.
Entity type:Organization
Organization Name:SPRINGTIDE CHILD DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-461-5410
Mailing Address - Street 1:PO BOX 358096
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-5096
Mailing Address - Country:US
Mailing Address - Phone:203-998-6678
Mailing Address - Fax:203-987-3099
Practice Address - Street 1:95 EASTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4582
Practice Address - Country:US
Practice Address - Phone:203-998-6678
Practice Address - Fax:203-987-3099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGTIDE CHILD DEVELOPMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty