Provider Demographics
NPI:1275855843
Name:TRINIDAD PEDIATRIC & ADULT THERAPY SERVICE
Entity Type:Organization
Organization Name:TRINIDAD PEDIATRIC & ADULT THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:719-680-2424
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2604
Mailing Address - Country:US
Mailing Address - Phone:719-846-4061
Mailing Address - Fax:719-846-4073
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2604
Practice Address - Country:US
Practice Address - Phone:719-846-4061
Practice Address - Fax:719-846-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty