Provider Demographics
NPI:1386203297
Name:CHILDREN ARE REALLY ACTIVE THERAPY,LLC
Entity Type:Organization
Organization Name:CHILDREN ARE REALLY ACTIVE THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/OT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER-CRUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:804-405-6316
Mailing Address - Street 1:4808 MARKET SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4826
Mailing Address - Country:US
Mailing Address - Phone:804-405-6316
Mailing Address - Fax:
Practice Address - Street 1:4808 MARKET SQUARE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4826
Practice Address - Country:US
Practice Address - Phone:804-405-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center