Provider Demographics
NPI:1275040438
Name:CENTER FOR PEDIATRIC THERAPY-FAIRFIELD, INC.
Entity Type:Organization
Organization Name:CENTER FOR PEDIATRIC THERAPY-FAIRFIELD, INC.
Other - Org Name:CENTER FOR PEDIATRIC THERAPY-DARIEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KACIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-255-3669
Mailing Address - Street 1:55 WALLS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5163
Mailing Address - Country:US
Mailing Address - Phone:203-255-3669
Mailing Address - Fax:203-255-1173
Practice Address - Street 1:455 POST RD STE 202
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3614
Practice Address - Country:US
Practice Address - Phone:203-424-2584
Practice Address - Fax:203-202-7310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR PEDIATRIC THERAPY-FAIRFIELD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0404140OtherORTHONET PROVIDER ID