Provider Demographics
NPI:1346347580
Name:SOUTH BAY CHILDRENS THERAPY CENTER INC
Entity Type:Organization
Organization Name:SOUTH BAY CHILDRENS THERAPY CENTER INC
Other - Org Name:CHILDRENS THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTRL
Authorized Official - Phone:408-842-1121
Mailing Address - Street 1:7881 EIGLEBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-842-1121
Mailing Address - Fax:408-842-3046
Practice Address - Street 1:7881 EIGLEBERRY STREET
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-842-1121
Practice Address - Fax:408-842-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty