Provider Demographics
NPI:1487036893
Name:CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER
Other - Org Name:DYNAMIC FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2583-216-5660
Mailing Address - Street 1:8717 S HOSMER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1819
Mailing Address - Country:US
Mailing Address - Phone:253-531-8873
Mailing Address - Fax:253-531-8615
Practice Address - Street 1:10811 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7108
Practice Address - Country:US
Practice Address - Phone:253-854-5660
Practice Address - Fax:253-854-7025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies