Provider Demographics
NPI:1407379464
Name:WHOLE KIDS THERAPY INCORPORATED
Entity Type:Organization
Organization Name:WHOLE KIDS THERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:408-280-7712
Mailing Address - Street 1:2066 CLARMAR WAY STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1715
Mailing Address - Country:US
Mailing Address - Phone:408-280-7712
Mailing Address - Fax:408-280-7721
Practice Address - Street 1:2066 CLARMAR WAY STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1715
Practice Address - Country:US
Practice Address - Phone:408-280-7712
Practice Address - Fax:408-280-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3384225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty