Provider Demographics
NPI:1275781700
Name:CHILDRENS THERAPY WORKS
Entity Type:Organization
Organization Name:CHILDRENS THERAPY WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:707-330-6949
Mailing Address - Street 1:2560 N TEXAS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1649
Mailing Address - Country:US
Mailing Address - Phone:707-330-6949
Mailing Address - Fax:
Practice Address - Street 1:2560 N TEXAS ST
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1649
Practice Address - Country:US
Practice Address - Phone:707-330-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation